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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.11.001 Byline: Alexandra Fickenscher, Douglas K. Novins, Janette Beals Keywords: Indian, North American; Adolescent; Substance abuse treatment centers; Motivation Abstract: This study assessed intrinsic and extrinsic motivation toward treatment among American Indian adolescents 13-18 years old admitted to a residential substance abuse treatment program and the relationship of these measures to treatment completion. Participants completed a questionnaire regarding motivation towards treatment and a diagnostic interview. Participant treatment records were also reviewed. Being an older adolescent (16-18 years old), having higher scores on a scale measuring treatment readiness and endorsing a single question regarding concern about legal problems were all associated with treatment completion. The relationship of an additional scale measuring desire for help with substance use problems was mediated by the measure of treatment readiness. This pilot study is the first to assess the relationship of motivation toward substance abuse treatment completion among American Indian adolescents and provides preliminary evidence of the applicability of these concepts to this treatment population. These concepts and their related therapeutic approaches warrant further study in this population. Author Affiliation: National Center for American Indian and Alaska Native Mental Health Research, University of Colorado at Denver and Health Sciences Center, Nighthorse Campbell Native Health Building, Mail Stop F800, P.O. Box 6508 Aurora, CO 80045-0508, U.S.A.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.04.006 Byline: Christina M. Mitchell, Janette Beals Keywords: American Indian; Alcohol use; Outcome expectancies; Growth mixture model Abstract: Adolescence is an important developmental period for understanding alcohol use. American Indian youth are a group for whom various preventive interventions focusing on alcohol use have been implemented but have not necessarily been widely successful, highlighting the need to further refine our approaches. In the work reported here, we followed 464 14- to 18-year-old American Indian youth annually for seven years. We examined the development of alcohol use and positive alcohol outcome expectancies in parallel, using growth mixture modeling to identify classes with different trajectories of alcohol use and expectancies. We found five classes; the largest (n =198) was made up of youth who experienced increases in both alcohol use and positive outcome expectancies. Initial levels of outcome expectancies were related to subsequent changes in alcohol use, while the reverse was not true, suggesting that interventions focusing on outcome expectancies are appropriate for a substantial number of youth. However, class heterogeneity in the relationships between the two processes pointed out that changes in expectancies may not always precede changes in alcohol use. Thus, intervention design implications are discussed for the class structures. Author Affiliation: American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Mail Stop F800, P.O. Box 6508, Aurora, CO 80045, United States

A study of the Center for Epidemiologic Studies-Depression Scale (CES-D) revealed that depression and somatic disorders are prevalent among American Indians in boarding schools. The study found a three-factor structure of CES-D to be most suited for the examination of factor structure for adolescent American Indians. Gender differences are likely to render factorial structures ineffective.

Background: Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification).Methods: The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit. Three multiple logistic regression models estimated the adjusted associations of each outcome separately with demographic/psychosocial characteristics, clinical characteristics, use related behaviors, and health care utilization.Results: Seventy-five percent completed detoxification treatment. Higher global assessment functioning scores, longer lengths of stay, and older ages of first alcohol use were associated with completing detoxification. A secondary drug diagnosis was associated with not completing detoxification. Thirty-six percent accepted a referral to substance abuse treatment following detoxification. Men, those with legal problems, and those with a longer length of stay were more likely to accept a referral to substance abuse treatment. Fifty-eight percent had a confirmed entry into a substance abuse treatment program at discharge. Length of stay was the only variable associated with substance abuse treatment entry.Conclusions: Services like motivational interviewing, counseling, development of therapeutic alliance, monetary incentives, and contingency management are effective in linking patients to services after detoxification. These should be considered, along with the factors associated with each point on the continuum of care when linking patients to follow-up services. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between depression and glycemic control in the Strong Heart Study (SHS), a longitudinal study of cardiovascular disease in American Indians.Methods: This cross-sectional analysis focused on the relationship between depression, diabetes and glycemic control among 2832 individuals aged > or =15 years. Depression was measured by the Center for Epidemiologic Studies of Depression Scale and diabetes by American Diabetes Association criteria. An ordered logit regression model was used to assess whether diabetes was related to level of depression (none, mild, moderate, severe). Multiple logistic regression was used to explore the relationship between A1c and severe depression in participants with diabetes.Results: Rates of depression were higher in men and women with diabetes when compared to those without diabetes, respectively (P<.05). For every 1-U increase in A1c, the odds of severe depression increased by 22% (OR 1.22, 95% CI: 1.05-1.42). Female sex (OR 2.97, 95% CI: 1.32-6.69) and body mass index (BMI) (OR 1.04, 95% CI: 1.00-1.08) also were significantly associated with increased risk for severe depression. Although BMI appears to be significantly associated with increased risk for severe depression, the magnitude of this effect was small.Conclusions: Individuals with diabetes have higher rates of depression than those without diabetes, consistent with other populations. There is a positive relationship between severity of depression and A1c levels; men and women with severe depression have higher A1c levels than those with moderate-to-no depression. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Background: To increase our understanding of the psychometric characteristics and factor structure of the SF36 in older American Indian populations.Methods: Between 1993 and 1995, SF36 data were collected from 3,488 Phase II participants of the Strong Heart Study (SHS) between the ages of 48 and 81. Comparison data were provided by an age- and gender-matched sample (n = 695) from the National Survey of Functional Health Status (NSFHS) conducted in 1989 and 1990.Results: Generally, the basic psychometric analyses showed that the SF36 performed adequately in these older American Indians. Exploratory factor analyses indicated that a one-factor model best fit the data for both older groups. On the other hand, confirmatory factor analyses showed that a two-factor model with correlated factors provided a superior fit to the data than a one-factor model. An assumption of equivalent factor loadings for the SHS and NSFHS groups was untenable.Conclusion: These analyses demonstrate that use of summary scores assuming a differentiated physical/mental functioning structure is likely improper in at least some populations. The SF36 provides an important opportunity to understand cultural differences in the conceptualization and measurement of health-related quality of life. [ABSTRACT FROM AUTHOR]

American Indians (AIs) have often reported higher rates of drug use than have other racial/ethnic groups. However, the majority of these studies have focused on drug use among high school adolescents, with little attention to pathological use such as drug abuse or dependence. This study is among the first to report lifetime drug use and disorder (abuse/dependence) information from community samples of two culture groups of AI people—one in the Southwest (SW), one in the Northern Plains (NP)—ranging in age from 15 to 57 years old. Analyses were conducted within four groups: SW men, SW women, NP men, and NP women. Across the four groups, lifetime use rates for marijuana (36.9–57.5%), cocaine (4.3–21.5%), and inhalants (3.6–17.0%) were the highest drug use rates; heroin (0.5–2.1%), the lowest. Lifetime drug disorder rates were highest for marijuana (4.5–14.1%), cocaine (1.1–2.3%), and stimulants (0.7–1.7%). Lifetime polydrug use disorder rates from 1.2 to 4.5%. Women generally had lower prevalence rates than did men in their culture group. The SW women generally had the lowest rates of use and disorder. Lifetime use and disorder rates among the youngest group were often not different from rates of the older groups. Overall, 40–60% had never used any drugs; 85–95% had not developed any drug disorder. Despite widespread concern and rhetoric about drug problems among AIs, many who had used various drugs either were using them without serious consequences or had quit use altogether. [Copyright &y& Elsevier]

Focuses on a study which investigated the pattern of the sequence of use of different classes of substances among a sample of Indian adolescents in the United States. Method used in the study; Prevalence and age of first use; Predictors of use of marijuana versus alcohol as initiating substance.

Highlights a study which investigated the total number of cases of psychiatric disorders among American Indian adolescents, detained on a Northern Plains reservation. Reference to the Diagnostic and Statistical Manual of Mental Disorders III criteria; Discussion on mental health services for adolescents suffering from emotional and behavioral disorders; Methodology used to conduct the study; Results of the study.

Presents a study which was conducted to evaluate the prevalence of psychiatric disorders among American Indian adolescents using data from the `Diagnosis Interview Schedule for Children' Version 2.1C. Number of participants in the study; Methodology used in the study; Results of the study.

Describes the patient population and use of mental health treatment at a substance abuse treatment program for American Indian and Alaska Native adolescents. Level of psychiatric symptomatology; Comparison of patient gender; Degree of association between patient psychiatric symptomatology and treatment received.

Describes the psychiatric symptomatology among the patient population, at a substance abuse treatment program for American Indian and Alaska Native adolescents. Comparison of the demographics, symptomatology and mental health treatment for male and female patients; Examination of the relationship between mental health treatment and patient psychiatric symptomatology; Indepth look at the medical records of 64 patients.

Emphasizes the importance of service system and community contexts as a potential explanation for the variation in prevalence of incarcerated Northern Plains American Indian adolescents. Detainment of youth for charges that are considered less severe; Factors responsible for detainment of teenagers; Expected rate of disruptive disorders among teenagers.

Abstract: Objectives: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). Methods: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n =3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. Results: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. Conclusions: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. Practice implications: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects of social support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence. [Copyright &y& Elsevier]

Abstract: The purpose of this analysis is to examine childhood characteristics associated with stage of substance use in adulthood in two American Indian (AI) populations. Data were drawn from an epidemiologic study of two AI reservation populations for persons age 18–44 years (n =2070). We used descriptive and multivariate analysis to examine correlates of four mutually exclusive stages of substance use: lifetime abstinence (Stage 0), use of alcohol only (Stage 1A), use of marijuana/inhalants with or without alcohol (Stage 1B), and use of other illicit drugs with or without the previously listed substances (Stage 2). Problematic substance use by parents, younger age of first substance use, initiating substance use with a drug (with or without alcohol), and adolescent conduct problems were associated with higher stage substance use. Persons who experienced sexual abuse, witnessed family violence, or experienced other traumatic events before the age of 18 were more likely to be at Stage 1B than Stage 1A. These findings underscore the importance of providing effective interventions during childhood and adolescence to reduce the risk of substance use progression. [Copyright &y& Elsevier]

American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15–57 yr) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (ptrend for Christianity=0.22 and ptrend for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (ptrend=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality. [Copyright &y& Elsevier]

Aims: The aims of this paper are to examine the relationship between psychological trauma symptoms and Type 2 diabetes prevalence, glucose control, and treatment modality among 3776 American Indians in Phase V of the Strong Heart Family Study. Methods: This cross-sectional analysis measured psychological trauma symptoms using the National Anxiety Disorder Screening Day instrument, diabetes by American Diabetes Association criteria, and treatment modality by four categories: no medication, oral medication only, insulin only, or both oral medication and insulin. We used binary logistic regression to evaluate the association between psychological trauma symptoms and diabetes prevalence. We used ordinary least squares regression to evaluate the association between psychological trauma symptoms and glucose control. We used binary logistic regression to model the association of psychological trauma symptoms with treatment modality. Results: Neither diabetes prevalence (22%–31%; p = 0.19) nor control (8.0–8.6; p = 0.25) varied significantly by psychological trauma symptoms categories. However, diabetes treatment modality was associated with psychological trauma symptoms categories, as people with greater burden used either no medication, or both oral and insulin medications (odds ratio = 3.1, p < 0.001). Conclusions: The positive relationship between treatment modality and psychological trauma symptoms suggests future research investigate patient and provider treatment decision making. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Research suggests that health literacy (HL) is associated with clinical outcomes. Few studies, however, have examined the mechanisms accounting for this relationship. To understand why HL is related to outcomes, we tested a theoretical framework proposing that diabetes-related knowledge and behavior mediate (explain) the relationship between HL and glycemic control (i.e., A1c). Methods: Analyses used baseline data from the Special Diabetes Program for Indians Healthy Heart Project (N =2594), an intervention to reduce cardiovascular risk among American Indians/Alaska Natives (AI/ANs) with diabetes. Three nested structural equation models tested the theoretical framework. Results: Model 1 demonstrated that participants with stronger HL skills had better glycemic control. Model 2 tested whether diabetes-related behaviors accounted for this relationship. Self-monitoring of blood glucose significantly mediated the HL-A1c relationship. Model 3 examined the role of diabetes knowledge, showing that it mediated the relationship between HL and dietary behavior. When knowledge was included, behavior was no longer a significant mediator, suggesting that knowledge was the main driver of the relationship between HL with A1c. Conclusion: Interventions to improve knowledge may be particularly important in enhancing outcomes among AI/ANs with diabetes. Practice implications: Strategies known to enhance patient comprehension may enable low-literate patients to develop needed diabetes knowledge. [Copyright &y& Elsevier]

Cultural competence models assume that culture affects medical encounters, yet little research uses objective measures to examine how this may be true. Do providers and racial/ethnic minority patients interpret the same interactions similarly or differently? How might patterns of provider–patient concordance and discordance vary for patients with different cultural characteristics? We collected survey data from 115 medical visits with American Indian older adults at a clinic operated by the Cherokee Nation (in Northeastern Oklahoma, USA), asking providers and patients to evaluate nine affective and instrumental interactions. Examining data from the full sample, we found that provider and patient ratings were significantly discordant for all interactions (Wilcoxon signed-rank test p ≤0.02). However, discordance typically reflected a trend in which providers were more critical of their own behaviors than were patients. These findings suggest that providers serving American Indian patients often create greater satisfaction than they believe. We then distinguished cultural subgroups of patients, comparing magnitude of provider–patient discordance on specific interactions for patients at different levels of American Indian and White American cultural identity. Patients who affiliated strongly with American Indian cultural identity more closely shared providers' reduced evaluation for several variables related to information exchange, as compared to patients who identified weakly. These results flag interactions that providers and their most culturally distinctive patients both experience as challenging. [Copyright &y& Elsevier]