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

American Indian and Alaska Native (AI/AN) youth face a history of adversity and trauma that are linked to academic and health concerns. Culturally grounded art-based interventions hold promise to address challenges faced by AI youth. AI culture and wisdom can evoke a sense of capability in youth that strengthens their resilience. This study sought to evaluate a culturally oriented art therapy curriculum on its impact on resilience, stress, and mood for AI youth (n = 36). A paired-samples t-test was conducted to compare the perceived stress scores of the participants before and after a 12-week art intervention. There was a significant decrease in participant perceived stress between the pre (M = 16.7, SD = 4.7) and post conditions (M = 20.4, SD = 4.6); t (24) =, -3.5 p = 0.002). A paired-samples t-test was conducted to compare the mood of each participant before and after each instance of art activity to see if there was a self-reported change in mood. There was a significant improvement in participant mood in 10 out of 11 of the intervention weeks. Although no statistically significant change was found in participant resilience, participants in this study did report high levels of resilience. This study provides promising evidence that a culturally salient after-school art curriculum program can reduce stress and improve mood for urban AI youth.

Despite their recent high-profile removal by a handful of professional sports teams, Native-themed mascots continue to be a mainstay of professional, college, and youth athletics. To determine the extent of the literature on the health impacts on American Indians and Alaska Natives (AI/ANs) as a result of Native-themed mascots, we conducted a scoping review of primary research articles, utilizing the National Institute on Minority Health and Health Disparities (NIMHD) research framework as a guide to define health impacts broadly to include impacts on determinants of health and health disparities. Three databases were utilized, MEDLINE/PubMed, PsycINFO, and JSTOR, to identify the peer-reviewed literature for a twenty-year period that studied the health impacts of Native-themed mascots. We found 26 articles and books in the peer-reviewed literature and additional gray literature during the time period of 1999-2019. To better identify the relationship between Native-themed mascots and health impacts, we reviewed the articles by their focus on three groups: AI/ANs generally, AI/AN youth, and those that studied all races/ethnicities. The majority of research included in this review illustrates overall negative impacts of Native-themed mascots on health and its determinants that influence health and health disparities. Public health efforts should include review and replacement of harmful Native-themed mascots in professional and academic sports to avoid negative health impacts on AI/AN adults and youth.

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

While progress has been made in learning more about American Indians and Alaska Natives (AI/ANs) who reside in Hawai'i, much more research is needed regarding adolescents' mental health and the major life events that they encounter. Utilizing a large cross-sequential epidemiologic design (N = 7,214; 1992-1996), this study found AI/AN-Hawaiian youth self-reported higher risk of predominantly negative major life events and mental health symptoms than for the non-Indigenous adolescent ethnic group, with the AI/AN and Native Hawaiian ethnic groups falling generally in between. However, when statistically controlling for covariates, overall, Native Hawaiian youth self-reported higher mental-health-symptom risk than the other three ethnic groups. Implications are discussed, including protective factors, prevention, and future research.

Mental health professionals that work with American Indian and Alaska Native (AI/AN) populations are often viewed as ineffective because their professional training is based on a Western model of service delivery that is an extension of Western colonization. Research on effective training approaches for AI/AN mental health providers or mental health professionals that work with AI/AN populations is limited. The purpose of this study is to document the experiences and impact of the Good Road of Life (GRL) training on mental health professionals that work with AI/AN populations. A cross sectional mixed-methods design was used to answer the primary research question, "What is the impact of GRL training on mental health professionals who work in American Indian communities?" We used GRL ratings, self-reported impacts, knowledge gains, and pre-post Sources of Strength scores. Self-reported mean knowledge scores increased for all topics. Daily evaluations indicate that most participants felt more positive, knew more about the impacts of sobriety, and knew how to help a suicidal person. Sources of Strength mean scores increased in the following areas: confidence, belonging, historical trauma, using strengths to overcome difficulties, spiritual practices, resolved unhealthy relationships, and use of cultural resilience. Results indicate that GRL is an effective short-term training for professionals working in the mental health field throughout Indian Country.

Utilizing data collected by the Monitoring the Future project between 2005-2015, this study assesses the effect of risk and protective factors in shaping the graduation expectations of urban American Indian/Alaska Native (AI/AN) students as compared to their non-Hispanic White (NHW) peers. The responses of nearly 150,000 8th- and 10th-grade students reveal that single race and multi-race AI/AN students experienced 13 of 15 risk factors at higher proportions than NHW students, and 12 of 15 risk factors corresponded to single race AI/AN students and a third of risk factors corresponded to multi-race AI/AN students having higher odds of expecting not to graduate. Additionally, for the majority of the 14 protective factors analyzed, both single race and multi-race AI/AN students showed lower odds of expecting to graduate compared to their NHW peers.

American Indians/Alaska Natives (AI/ANs) are subject to widespread cultural misrepresentations ranging from intrusive questions about ethnic identity to Native-themed sports team mascots. Racial microaggressions are linked to negative physical health, mental health, and academic consequences for AI/ANs. This study examines microaggressions experienced by AI/AN post-secondary students in New Mexico and Oklahoma. Microaggression prevalence ratings and associated distress were compared across region, gender, income, age, and cultural involvement. Results showed microaggressions were highly prevalent among AI/AN students in New Mexico and Oklahoma and varied by demographic and cultural factors. Increased AI/AN microaggressions research is needed to bring awareness, education, and solutions.

American Indians and Alaska Natives experience pervasive mental, behavioral, and physical health disparities, yet access to culturally relevant and evidenced-based programs (EBPs) are severely limited. The purpose of this research is to describe the process of conducting a rigorous and culturally sensitive research approach, which was used to inform the development of a family-based substance abuse and violence prevention program that promotes resilience. The focus of this article is on the process of this development, rather than the intervention itself. We utilize a convergent mixed-methods design with distinct tribes in the Southeast that included 436 research participants across individual, family, and focus group interviews, field notes and existing data, and a quantitative survey (n = 127). This community-engaged, culturally sensitive, and rigorous research methodology provides a road-map for developing culturally relevant interventions.

The Culture is Prevention Project is a multi-phased communitybased participatory research project that was initiated by six urban American Indian and Alaska Native (AI/AN) health organizations in northern California. Issues driving the project were: i) concerns about the lack of culturally informed or Indigenous methods of evaluating the positive health outcomes of culture-based programs to improve mental health and well-being; and ii) providing an approach that demonstrates the relationship between AI/AN culture and health. Most federal and state funding sources require interventions and subsequent measures focused on risk, harm, disease, and illness reduction, rather than on strength, health, healing, and wellness improvement. This creates significant challenges for AI/AN communities to measure the true impact of local strength and resiliency-based wellness programs. This paper focuses on the methods and results from Phase 3 of the Culture is Prevention Project where we adapted the 29-item Cultual Connectedness Scale (CCS), developed in Canada, to be appropriate for California's multi-tribal communities. The resulting new Cultural Connectivity Scale - California (CCS-CA) was developed by urban AI/AN people for urban AI/AN people. The process, instrument, how to adapt for your community, and implications are reviewed.

This review examined validation studies of the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) to identify an appropriate postpartum depression (PPD) screening tool for American Indian and Alaska Native (AI/AN) women in the U.S. Databases were searched using: EPDS paired with psychometric properties or validation and PHQ-9 paired with PPD and psychometric properties or validation, yielding a final sample of 58 articles. Both tools have good internal consistency, but discriminative validity for detecting PPD in women from non-Western cultures is low. Positive predictive values in these women are low and diverse (EPDS [n = 21] median 67%, range 21.1-90%; PHQ-9 [n = 1] median 26%). The low predictive accuracy of both tools suggests the tools may be culturally biased.

American Indians and Alaska Natives (AI/ANs) constitute 2.2% of Hawai'i's population. Unfortunately, very little is known about the mental health of AI/AN youth in Hawai'i. The purpose of this study (N = 7,214; 1992-1996) was to describe AI/AN adolescents versus non-AI/AN youth regarding demographic, social, and mental health variables. The results suggested that AI/AN adolescents were more open to different types of social-emotional supports, had relatively more non-traditional families with a smaller social network, and may be more vulnerable to academic and health difficulties, with particular risk for mental health issues for mixed AI/AN-Native Hawaiians. Implications are discussed, including intervention, socio-political issues, and future research.

Alaska Native and American Indian (AN/AI) people experience a disproportionate burden of health disparities in the United States. Including AN/AI people in pharmacogenetic research offers an avenue to address these health disparities, however the dissemination of pharmacogenetic research results in the community context can be a challenging task. In this paper, we describe a case-study that explores the preferences of AN/AI community members regarding pharmacogenetic research results dissemination. Results were presented as a PowerPoint presentation at the 2016 Alaska Native Health Research Forum (Forum). An audience response system and discussion groups were used to gather feedback from participants. Descriptive statistics were used to assess attendee understanding of the presentation content. Thematic analysis was used to analyze discussion group data. Forum attendees needed time to work through the concept of pharmacogenetics and looked for ways pharmacogenetics could apply to their daily life. Attendees found pharmacogenetics interesting, but wanted a simple description of pharmacogenetics. Community members were optimistic about the potential benefit pharmacogenetic medicine could have in the delivery of health care and expressed excitement this research was taking place. Researchers were urged to communicate throughout the study, not just end research results, to the community. Furthermore, attendees insisted their providers stay informed of research results that may have an impact on health care delivery. Conversational forms of dissemination are recommended when disseminating pharmacogenetic research results at the community level.

We examined social and physical violence experienced by American Indian/Alaska Native (AI/AN) women in prostitution and their impacts on the mental and physical health of 105 women (81% Anishinaabe, mean age = 35 years) recruited through service agencies in three Minnesota cities. In childhood, abuse, foster care, arrests, and prostitution were typical. Homelessness, rape, assault, racism, and pimping were common. The women's most prevalent physical symptoms included muscle pain, impaired memory or concentration, and headaches. Symptoms of post-traumatic stress disorder and dissociation were common, with more severe psychological symptoms associated with worse health. Most of the women wanted to leave prostitution and they most often identified counseling and peer support as necessary to accomplish this. Most saw colonization and prostitution of AI/AN women as connected.

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between observed and expected costs. Culturally specific residential substance abuse treatment services can be provided to urban AI/ANs within budgets typically found at mainstream programs.

This study describes the development and evaluation of Native Generations, a campaign addressing high rates of infant mortality (IM) among American Indians and Alaska Natives (AI/ANs) in urban areas. Campaign development included reviews of literature and previous campaigns, an advisory council, and focus groups. Campaign messages are strength-based, encouraging AI/AN caregivers to utilize available Native-specific resources, including health care, support services, and programming as IM protective factors. The primary campaign material is an 11-minute video. Pilot survey data indicate the video may help increase awareness of IM and Native-specific resources, and increase connection to Native identity, culture, and community.

Examining American Indian and Alaska Native (AI/AN) resilience using the life course framework could inform public health strategies that support favorable health outcomes, despite adversity (e.g., discrimination, historical loss, comorbidity). A systematic review of peer-reviewed literature published from 1970 to 2015 yielded eight articles on AI/AN life course and resilience. A content analysis identified three themes. AI/AN resilience is 1) an ongoing, dynamic process, 2) evident within linked lives and life transitions, and 3) accessed through cultural knowledge and practice. Resilience research could change the paradigm of AI/AN health research to guide asset-based approaches across the life course.

Understanding youths' awareness and use of behavioral health services is important for improving services and engagement. Interviews and focus groups were conducted with students, parents, and teachers/staff in an urban area to understand awareness and use of a school's Native-tailored and -staffed school-based behavioral health center (NT-BHC) and community-based services. Results showed overwhelmingly positive responses regarding NT-BHC staff and services, with concerns focused on too few staff and services, and on privacy and confidentiality, as well as important differences in awareness and use of behavioral health services among youth, parents, and teachers/staff, valuable for improving engagement with and services for AI/AN youth.