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Black Alaskans face serious barriers to health care. This paper reports on qualitative results of a health needs assessment to understand the health challenges facing Black Alaskans. Utilizing exploratory thematic analysis, the findings indicate that Black Alaskans experience barriers such as high cost of care, underinsurance, lack of information and education, a shortage of BIPOC health providers, stigma, negative perceptions by health-care providers, and racism both in the community and in the health-care system. The paper concludes by discussing emerging health equity initiatives to advance responsive care for Black Alaskans. [ABSTRACT FROM AUTHOR]

Background: Historical trauma experienced by Indigenous peoples of North America is correlated with health disparities and is hypothesized to be associated with DNA methylation. Massive group traumas such as genocide, loss of land and foodways, and forced conversion to Western lifeways may be embodied and affect individuals, families, communities, cultures, and health. This study approaches research with Alaska Native people using a community-engaged approach designed to create mutually-beneficial partnerships, including intentional relationship development, capacity building, and sample and data care. Methods: A total of 117 Alaska Native individuals from two regions of Alaska joined the research study. Participants completed surveys on cultural identification, historical trauma (historical loss scale and historical loss associated symptoms scale), and general wellbeing. Participants provided a blood sample which was used to assess DNA methylation with the Illumina Infinium MethylationEPIC array. Results: We report an association between historical loss associated symptoms and DNA methylation at five CpG sites, evidencing the embodiment of historical trauma. We further report an association between cultural identification and general wellbeing, complementing evidence from oral narratives and additional studies that multiple aspects of cultural connection may buffer the effects of and/or aid in the healing process from historical trauma. Conclusion: A community-engaged approach emphasizes balanced partnerships between communities and researchers. Here, this approach helps better understand embodiment of historical trauma in Alaska Native peoples. This analysis reveals links between the historical trauma response and DNA methylation. Indigenous communities have been stigmatized for public health issues instead caused by systemic inequalities, social disparities, and discrimination, and we argue that the social determinants of health model in Alaska Native peoples must include the vast impact of historical trauma and ongoing colonial violence. [ABSTRACT FROM AUTHOR]

A qualitative, hermeneutic, phenomenological, holistic case study was completed to gain insight into the experiences of drug and alcohol (D&A) counselors in rural Alaska. The goal was to describe why counselors in rural Alaska work in their positions and continue to perform, despite existing research indicating challenges in the occupation and the location. Interviewing homogeneous, purposively selected D&A counselors working in rural Alaska provided rich experiential information answering the research question. The approach to information gathering and analyses of interview transcripts for common themes captured the lived experiences of the counselors. It illuminated their perceptions of incentives supporting and encouraging their service. Counselors' stories highlighted common themes known to the field (challenges, stigma) and themes previously unnamed but taken-for-granted (community/ giving-back, prevention, personal/professional growth). The nation's addiction problems are not decreasing; intervention by skilled professionals is needed. The authors' searches of existing literature revealed no qualitative research describing why counselors persist. Results indicated that despite challenging deadlines, politics, stigma, and more, counselors certainly enjoy their work, allowing them to give back to their communities and save lives. Counselors also appreciate the personal and professional growth opportunities provided to them. Conclusions suggested future research regarding recruitment and retention, such as personal experience with addiction, being an established community member, and the desire for opportunities to provide unique and professional growth. In addition, governmental and professional organizations should better support counselors in their essential work. [ABSTRACT FROM AUTHOR]