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Information about the equality of psychometric properties of the medical outcomes study (MOS) Short Form-36 (SF-36), a health status measure, across gender and across the lifespan for American Indian adults is lacking. We tested measurement invariance (configural, metric, scalar invariance) of the physical and mental components between gender and over time in a sample of 2,709 (1,054 men, 1,654 women) American Indian older adults at three time points, and across a 6-year time frame. Measurement invariance of a 2-factor higher-order model was demonstrated between gender at each time point. Tests of longitudinal invariance indicated longitudinal measurement invariance over time. Multiple-group latent means analysis indicated men had significantly higher physical and mental component latent means compared to women at each time point, and longitudinal latent means analysis found physical and mental component latent means decreased over time. The 2-factor higher-order model SF-36 is valid for American Indian older adults over a 6-year time frame. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Previous studies report that obesity can be a risk and a protective factor for cognitive health. However, they have not examined whether white matter hyperintensities (WMH) mediate the association between mid- or late-life body mass index (BMI) and late-life cognitive performance. We examined this question in American Indians, a population underrepresented in neuropsychological research.We used longitudinal data from the cerebrovascular disease and its consequences in American Indians (n = 817), with BMI data collected at midlife (1989-91) and lat-life (2010-13). Cognitive data were collected in late life, with tests for general cognition, processing speed, verbal fluency, and memory. Neuroradiologist-scored WMH severity and volume using standard analysis pipelines. We examined associations among BMI, WMH severity and volume, and cognitive scores using linear regression and the Baron and Kenny method to estimate mediation.High BMI in late life was associated with a 1.79-point higher score in general cognition (95% CI 0.63-2.95, p-value = 0.002), but not the other tests. Mediated by WMH severity, high late-life BMI was associated with a 1.53-point higher score in general cognition (95% CI 0.37-2.69) and, by WMH volume, 1.63 points higher (95% CI 0.49-2.77). The association between late-life obesity and cognitive performance is stronger for females (β = 1.74, 95% CI 0.35-3.13, p-value = 0.014) than for males (β = 1.66, 95% CI -0.63-3.95, p-value = 0.158).In American Indians, high late-life BMI was positively associated with cognitive performance, with a stronger association for females. WMH severity and volume partly attenuate these associations.

Diet quality has been shown to be inversely associated with depression, but this has not been studied in American Indians (AIs). We examined the prospective association of diet quality and probable depression in a family-based cohort of rural AIs. Using data from the Strong Heart Family Study, we included 1,100 AIs ≥14 years old who were free of probable depression at baseline. We defined probable depression as the presence of moderate or severe depressive symptoms on the Center for Epidemiologic Studies Depression Scale or current use of antidepressant medications. We calculated baseline diet quality from food frequency questionnaires using the Alternative Healthy Eating Index-2010 (AHEI). We used GEE-based multivariate logistic regression to estimate the odds ratio of probable depression at follow up associated with a 10-point higher AHEI score at baseline, adjusted for demographic, psychosocial, and health factors. At follow up, 19% (n = 207) of the sample reported probable depression. Diet quality was not associated with report of probable depression at follow up (OR = 1.16, 95% CI [0.96, 1.39]). Research is needed to examine other temporal dimensions of this relationship and unique aspects of rural AI diets and psychosocial factors that may influence depression.

Prior studies with Native populations have highlighted concerns about the cultural acceptability of highly directive, Eurocentric approaches, such as cognitive behavioral therapy and 12-step programs in treating alcohol use disorder (AUD). When asked in a prior qualitative study how they would redesign AUD treatment, urban American Indian and Alaska Native (AI/AN) participants reported wanting more low-barrier, harm-reduction treatment options, Native treatment providers, and culturally relevant practices. Talking Circles, which are gatherings where people share what is on their hearts, were the most requested Native cultural practice. After developing and piloting its initial iteration, researchers, community members, and traditional health professionals collaborated on the present qualitative research study to further refine an adapted Harm Reduction Talking Circle (HaRTC) protocol to address AUD with urban AI/ANs. This study features a conventional content analysis of 31 patient interviews, 6 key informant interviews with management and traditional health professionals, and 5 staff and provider focus groups to inform the development of the HaRTC. Specifically, this study describes staff, management, traditional health professionals, provider, and patient participants’ a) perspectives on HaRTC, including potential benefits, risks and mitigating factors, b) preferred traditional medicines and practices, c) preferred approaches/Circle Facilitator stance for engagement and facilitation, and d) HaRTC logistics (e.g., timing, frequency). Analyses indicated a central tendency preference for 8, weekly HaRTC sessions. Although participants expressed concerns about the potential inclusion of intoxicated people in HaRTC sessions, a large majority of staff, management and patient participants felt it was important to have HaRTC be as inclusive and accepting of community members as possible. Participants provided suggestions for how to structure facilitation of the HaRTC and mitigate risks of intoxication and patient escalation. Participants preferred an approach that is acceptance-based, respects individuals’ autonomy and culture, and creates a safe space for recovery. Most participants felt the specific traditions and medicines applied in the HaRTC should be maximally inclusive to honor the diversity of tribal affiliations and backgrounds represented among urban AI/ANs. In conclusion, participants largely supported an integration of harm-reduction principles and the North American Indigenous tradition of the Talking Circle to provide a compassionate, culturally appropriate healing practice to a larger spectrum of AI/ANs with AUD. Future research is planned to test the efficacy of this community-informed approach.

Despite their intrinsic strengths and resilience, some American Indian and Alaska Native (AI/AN) communities experience among the highest rates of suicide of any racial and ethnic group. Caring Contacts is one of the only interventions shown to reduce suicide in clinical trials, but it has not been tested in AI/AN settings.To compare the effectiveness of Enhanced Usual Care (control) to Enhanced Usual Care augmented with a culturally adapted version of Caring Contacts (intervention) for reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations.We are implementing a single blind randomized controlled trial of Caring Contacts in five AI/AN communities across the country (South Dakota, Montana, Oklahoma, and Alaska). Eligible participants have to be (1) actively suicidal or have made a suicide attempt within the past year; (2) at least 18 years of age; (3) AI/AN; (4) able to speak and read English; (5) able to participate voluntarily; (6) willing to be contacted by text, email or postal mail; and (7) able to provide consent. Following consent and baseline assessment, participants are randomized to receive either Enhanced Usual Care alone, or Enhanced Usual Care with 12 months (25 messages) of culturally adapted Caring Contacts. Follow-up assessments are conducted at 12 and 18 months.If effective, this study of Caring Contacts will inform programs to reduce suicide in the study communities as well as inform future research on Caring Contacts in other tribal settings. Modifications to continue the trial during the COVID-19 pandemic are discussed.NCT02825771.