Conceptions of wellness among the Yup'ik of the Yukon-Kuskokwim Delta: the vitality of social and natural connection

Focus group research was conducted to examine indigenous conceptions of wellness among the Yup'ik Eskimos of southwestern Alaska. The dialogue on wellness emphasized the importance of living a traditional lifestyle, seeking creative solutions to manage drastic cultural change, and fostering connection within the communities and the native landscape. These themes mesh well with existing characterizations of Alaska Native experiences and worldviews, and reflect substantial links between enculturation, acculturation and health. The data underscores the importance of comprehending local conceptions of wellness in order to effectively work toward promoting optimal health. This paper represents part of an ongoing dialogue in which researchers and native communities co-direct the investigation into healthy ways of being in the world.     

Historical Oppression and Indigenous Families: Uncovering Potential Risk Factors for Indigenous Families Touched by Violence

Violence against Indigenous women in the United States is higher than for any other racial group. Indigenous women tend to rely on families for support and recovery, yet the risk factors related to Indigenous families affected by violence are unknown. Therefore, interviews from a critical ethnography were used to uncover the perspectives of Indigenous women who have experienced intimate partner violence, along with the professionals who serve them, to understand potential risk factors that create vulnerability to and impair recovery from violence. Several themes emerged from pragmatic horizon analysis of interviews with 49 Indigenous women and professionals who work with tribal members affected by violence, including family divisions and parental impairments (i.e., intergenerational patterns of absent parental figures, parental alcohol abuse, and impaired bonding). Future research should examine these potential risk factors related to families affected by violence and their connections with historical oppression.     

Impacting Sexism through Social Justice Prevention: Implications at the Person and Environmental Levels

Sexism in our society leads to multiple negative outcomes for women. Although traditional therapeutic approaches as well as preventive interventions address the specific negative outcomes of sexism, they rarely utilize a social justice approach. The deleterious effects of sexism occur complexly; sexist interpersonal events often occur within family systems that may endorse traditional gender roles, which exist within a societal and cultural context that contains sexist norms and formalized sexist policies. These multifaceted, ingrained circumstances delineate the need for preventive social justice to address sexism on multiple levels. A prevention/social justice model will be used to critique existing interventions and identify avenues for change in research and practice.     

Environmental health perceptions of urban youth from low-income communities: A qualitative photovoice study and framework

Background

Children are amongst the most susceptible groups to environmental exposures, for both immediate and life-course health outcomes. Despite their increased susceptibility, children's knowledge, experiences and voices are understudied. A deeper understanding of children's environmental health perceptions has the potential to better inform policy, develop targeted interventions and improve public health outcomes.

Methods

In this study, our community–academic partnership used the Photovoice research method to examine how urban children from low-income communities perceive environmental influences on their health. Twenty children, ages 10–12, took photographs and participated in focus group interviews regarding their perspectives on how the environment influences their health.

Results

Qualitative analyses revealed five major thematic categories: environmental exposures, environmental health sentiments, environmental health outcomes, interest in environmental health and environmental health solutions. We used the findings to develop an environmental health perspective theoretical framework that can inform future work designed to promote the environmental health and well-being of children from low-income communities in urban communities.

Conclusion

Photovoice enabled children from low-income communities to capture and communicate their environmental health perceptions. These findings have the potential to inform and identify potential targets and opportunities for environmental health interventions and promotion in their communities.

Patient or Public Contribution

Partnerships with community-based organizations were central to the present study. By design, these community-based partners were involved in the conduct and procedures of the study.     

Reproductive Attitudes and Behaviors in People With Sickle Cell Disease or Sickle Cell Trait: A Qualitative Interpretive Meta-Synthesis

Sickle cell disease (SCD) is a serious and life threatening disorder. The literature on informed reproductive decisions among people with SCD is limited, suggesting that there is a lack of awareness about SCD and Sickle cell trait status (SCT) among high-risk populations. The purpose of this qualitative interpretive meta-synthesis (QIMS) is to examine the reproductive attitudes and behaviors in people with SCD or SCT to create effective genetic counseling programs to inform reproductive decision making. Three studies were included in the QIMS for a total sample of 79 participants. The majority of the sample was African American, ages 16 to 63. Other demographic characteristics of the study populations and data collection methods used in these studies varied. Seven themes on reproductive attitudes and behaviors among people with SCD or SCT emerged: lack of awareness or education about SCD and SCT; men who deny having SCT; attitudes toward learning one's SCT status; rationales for learning a partner's SCT status prior to commencing a relationship; valuing relationships over SCD risk; learning one's own and partner's SCT status; and the consequences of not asking about partners' SCT status. Implications for prevention programming involving improved education and awareness about the disease and reproduction are discussed.     

Examining the Lives of Navajo Native American Teenage Mothers in Context: A 12‐ to 15‐Year Follow‐Up

In 1992 and 1995, data were collected from 29 Navajo, reservation‐residing teenage mothers. In 2007, follow‐up data from 69% (n= 20) of the original sample were collected. Intensive interviews, grounded in ecological systems theory ( U. Bronfenbrenner, 1989 ), allowed for contextual examination of the women’s developmental trajectories. Significant educational accomplishments and a strong work ethic (i.e., individual level) exemplified the majority of respondents. Relationships with families of origin and intimate partners (i.e., microsystems) and connections between these (i.e., mesosystems) promoted and challenged participants’ optimal development and were significantly influenced by macrosystem factors (e.g., economic constraints, physical isolation). Implications for service provision and continued research are discussed.     

Environmental health disparities: a framework integrating psychosocial and environmental concepts

Although it is often acknowledged that social and environmental factors interact to produce racial and ethnic environmental health disparities, it is still unclear how this occurs. Despite continued controversy, the environmental justice movement has provided some insight by suggesting that disadvantaged communities face greater likelihood of exposure to ambient hazards. The exposure-disease paradigm has long suggested that differential "vulnerability" may modify the effects of toxicants on biological systems. However, relatively little work has been done to specify whether racial and ethnic minorities may have greater vulnerability than do majority populations and, further, what these vulnerabilities may be. We suggest that psychosocial stress may be the vulnerability factor that links social conditions with environmental hazards. Psychosocial stress can lead to acute and chronic changes in the functioning of body systems (e.g., immune) and also lead directly to illness. In this article we present a multidisciplinary framework integrating these ideas. We also argue that residential segregation leads to differential experiences of community stress, exposure to pollutants, and access to community resources. When not counterbalanced by resources, stressors may lead to heightened vulnerability to environmental hazards.     

Problems and Pitfalls in Conducting Epidemiological Research in the Area of Reproductive Toxicology

Defective reproductive outcome continues to represent a considerable public health burden, as well as a source of intense personal tragedy and enormous expense in our society. Evidence suggests that the rate or reproductive failure may be modifiable, in part by limiting human exposure to environmental agents toxic to the reproductive process. Methodological problems posing difficulties to researchers investigating the association between exposure to such agents and adverse reproductive outcome are discussed, including inadequacies in existing data bases available for analysis; bias in reporting by or in the collection of information From affected families: and weaknesses in the selection of study populat ions. “control” groups, and outcomes chosen for observation. Suggestions For possible resolution of some of these difficulties are discussed.     

A comparison of respiratory conditions between multiple race adults and their single race counterparts: an analysis based on American Indian/Alaska Native and white adults

Context. Multiple race data collection/reporting are relatively new among United States federal statistical systems. Not surprisingly, very little is known about the multiple race population in the USA. It is well known that some race and ethnic groups experience some respiratory diseases (e.g., asthma) disproportionately. However, not much is known about the experience of multiple race adults. If differences exist in how single/multiple race adults experience respiratory conditions, this information could be useful in public health education.

Objective. To explore differences in respiratory conditions between single race white adults, single race American Indian/Alaska Native (AIAN) adults, and adults who are both white and AIAN (largest multiple race group of adults in the USA).

Methods. Data from the National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, were analyzed. Hispanic and black populations are oversampled. Multiple logistic regressions were performed to predict if the occurrence of each respiratory condition analyzed differed by single/multiple race reporting.

Sample. A nationally representative sample of 127,596 civilian non-institutionalized adults (≥18 years of age) from the 2000–2003 NHIS.

Outcome measure. Adults told by a doctor or other health professional that they had asthma, hay fever, sinusitis, and/or chronic obstructive pulmonary disease.

Results. Adults who are both AIAN and white generally had higher rates of respiratory conditions than did their single race counterparts. These differences persisted even after controlling for socio-demographic and health care access measures.

Conclusions. This paper presents some of the first research of how the health of some multiple race adults differs from their single race counterparts. Contrary to some previous expectations for these estimates, respiratory condition estimates for adults who are both AIAN and white do not appear to be located between those of the component single race groups.     

Race/ethnicity and depressive symptoms: a cross-cultural/ethnic comparison among university students in East Asia,North and South America

To examine manifestations of depressive symptomatology among undergraduate students in East Asia, North and South America, responses to the Center for Epidemiologic Studies Depression Scale (CES-D) were compared across Japanese (n = 310), Anglo-American (n = 377), Native American (n = 353), and Argentinean (n = 110) undergraduate students. Japanese reported a significantly higher level of low positive affect, leading to significantly higher total CES-D scores, whereas their negative symptoms score was comparable to scores of Anglo-Americans and Argentineans. Although Native Americans were more likely to endorse negative symptoms, their low positive affect score was comparable to those of Argentineans. Argentineans appear to suffer less from depressive symptoms. Results from a Differential Item Functioning analysis, using Anglo-Americans as the reference group, indicated that: (1) the manifestation of depressive symptoms seemed to be similar for Anglo-Americans and Argentineans, except for low positive affect; (2) Native Americans tended to favor somatic symptoms over affective (depressive) symptoms; (3) responses to positive affect questions could possibly be biased not only for Japanese but also for people in North America; i.e., the expression of positive affect might be enhanced in North American culture, while inhibited in Japanese culture.     

Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study

ObjectivesMost people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services.MethodsWe conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care.ResultsIndigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%.ConclusionOur study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00482-y.     

Dietary Intake Patterns and Lifestyle Behaviors of Pregnant Women Living in a Manitoba First Nations Community: Implications for Fetal Alcohol Spectrum Disorder

The information on the nutrition status of women at-risk of carrying a child with fetal alcohol spectrum disorder (FASD) is scarce, particularly in the First Nations population living on reserve. This study examined and compared nutrition status, dietary intake, and lifestyle patterns of pregnant at-risk, defined as those who consume alcoholic drink during the current pregnancy, and non-at-risk women living in northern Manitoban community. Thirty-seven pregnant, First Nations women (at-risk n = 15; non-at-risk, n = 22) were recruited to participate in the study. A questionnaire, presented in paper and iPad formats, collected information on participants’ demographics, dietary intake, lifestyle, pregnancy outcomes, and maternal health. A food frequency questionnaire and 24-h recall were used to determine nutrient intake. Nutrient values were assessed using Dietary Reference Intakes (DRI). At-risk and non-at-risk women were below the Canada Food Guide serving size recommended for Vegetable and Fruit, Grain, and Milk Products with 93%, 92%, and 93% of participants not meeting the recommendations, respectively. Women met the recommendations for vitamins A, B1, B12, C, niacin, choline, as well as calcium, and zinc. Sixty eight percentage (%) of participants did not meet the recommendations for folate and iron, and 97% for docosahexaenoic acid (DHA). Significant differences were observed between non-at-risk and at-risk women for mean % DRI intakes of vitamin C (313 ± 224 vs. 172 ± 81 mg/day), niacin (281 ± 123 vs. 198 ± 80 mg/day), folate (70 ± 38 vs. 10 ± 22 mcg/day), and iron (101 ± 74 vs. 74 ± 30 mg/day). The findings of this study lay a fundamental premise for the development of community nutrition programs, nutrition education, and nutrition intervention, such as community specific prenatal supplementation. These will assist in ensuring adequate maternal nutrient intake and benefit families and communities in Northern Manitoba with and without alcohol insult.     

Social Justice and the Future of Healthy Families: Sociocultural Changes and Challenges

Given the pace of social changes, meanings of “family” and what makes a family healthy are changing. How can these changing meanings and understandings contribute to social justice for all families? First, I acknowledge how my personal history has intersected with research I do on youth and families. I define social justice with respect to healthy families, and then consider how contemporary scholarship helps define, redefine, and refine what is meant by “family.” Examples are presented from research on cultural influences on parenting; parenting in same‐sex couple or lesbian, gay, bisexual, transgender, or queer (LGBTQ) families; and coming out in adolescence as LGBTQ. These examples illustrate how the notion of family is defined, redefined, and refined to provide new vantage points on the complexities, possibilities, and potential for social justice among contemporary families, especially those that are marginalized.