2014 CRCAIH Pilot Grants Program Awardees
Impact of residential treatment on American Indian maternal-child health outcomes
Emily Griese, PhD, (Sanford Research)
The overarching objective of the proposed project is to better understand the health outcomes of both American Indian mothers who have undergone residential substance abuse treatment and their children. To accomplish this objective, the proposed research project will examine the impact of an existing, community-based residential treatment program for pregnant and/or parenting women with a substance use disorder on maternal-child health and the home environment following treatment. The majority of participants in this program are American Indian therefore the current study will further work to identify potential areas of development regarding the cultural-relevance of the New Start program and its impact on the health outcomes of American Indian women and children. Prior research highlights the impact of substance abuse not only on the health outcomes of pregnant and/or parenting women, but further, suggests the detrimental impact substance abuse can have on the health outcomes of the child. However, while residential substance abuse treatment programs have worked to assess the outcomes of mothers receiving their services, they have often overlooked the potential impact residential treatment services may have on the postnatal environment and subsequent health outcomes of the mother and child. Therefore, it is a goal of the proposed study to examine the impact of New Start, a residential treatment program for pregnant and/or parenting women with a substance abuse dependency, on the maternal-child health and home environment 3-12 moths post-treatment (SA1). Mother-child dyads that have successfully completed the New Start program and are living in a transitional living facility will be recruited to take part in a one hour, in-home assessment examining the mother-child relationship and the overall home environment. Analyses will focus on the impact of the New Start program on outcomes of the in-home assessment, with attention given specifically to differences between Native and non-Native mother and child outcomes. Given that the majority of the participants in the New Start program are American Indian women, a goal of this project is also to examine the cultural-relevance of the New Start program and its desired outcomes for American Indian women and their children (SA2). Interview questions exploring the cultural relevance of the services provided by New Start and its impact on the health outcomes of American Indian mothers and children will further be assessed in the one hour home visit. Given findings from the in-home assessment and interview, program recommendations will be developed and delivered to the New Start program regarding their cultural-relevance for American Indian women and maternal-child health (SA3). There is great significance in the current study as it fills a void in the current research regarding the importance of the maternal-child relationship for the long-term success for both mothers and children following residential treatment programs. It is also innovative in its approach assessing both maternal and child outcomes utilizing an in-home assessment following treatment and examining the cultural sensitively of the New Start program for American Indian participants.
American Indian pilot study on caregiving attachment and health of young children
MaryLou Mylant, PhD, (South Dakota State University)
This study is designed to better assess and strengthen the quality of caregiving among American Indian/Alaska Native (AI/AN) young families in order to help decrease the health disparities specific to physical activity and nutrition that are related to the onset of diabetes. Our first aim is to test the efficacy of the AI Strengthening Family Program (SFP); a family skills training program that has shown to positively affect the quality of caregiving, as well as physical activity and nutritional health. Our community partner seeks this support for AI/AN families of children, ages 3-5 who have been without community early childhood services for the last several years. This study employs a Community Based Participatory Research (CBPR) approach that combines the knowledge and action of our community partner who through informal collaboration with the co-investigator has successfully decreased the levels of overweight and obesity among first through eighth grade children through physical activity and nutrition and now is seeking support for their preschool students and caregivers. Currently, 80% of the AI/AN preschool students’ Body Mass Index (BMI) measurements are considered overweight or obese. Overweight and obesity are considered to be the most serious health problems facing AI/AN children and are early antecedents of significant health problems across the life span. AI/AN adults who were obese as children have a mortality rate more than twice that of adults who were not obese as children. Most concerning is a 27% increase in the number of AI/AN children (aged 15 years and younger) who were diagnosed with type 2 diabetes over a recent 8-year period in the Indian Health Service Great Lakes Region.
We seek to link our community partner’s success in addressing this serious health issue to the added value of the AI-SFP program that has had very favorable outcomes in terms of caregiving, physical activity, and nutritional education. Our central hypothesis is that exposure to the AI-SFP program will increase the physical activity and nutritional knowledge of the caregivers and decrease the level of overweight/obesity (BMI >85%) among AI/AN preschool children.
Our secondary hypothesis is that exposure to the AI SFP program will improve the social-emotional health of the preschool children, as well as the quality of caregiving. Our goal is to describe the link between quality care giving, adult attachment patterns of the caregivers and health outcome. The protective effect of attachment patterns for both adults and children has not been adequately explored among AI/ANs. As a second aim we will evaluate a caregiver attachment instrument that is a picture-based story-telling measure, which we believe will be more culturally relevant for assessing attachment patterns among AI/AN caregivers than current adult attachment instruments. A critical barrier to the study of attachment is a lack of culturally-adapted measures of adult attachment patterns; which is a critical need for programs such as the AI-SFP program that strengthen families and promote protective effects, resulting in improved child health. Our long-term goal is to promote strong AI/AN families and improve child health.
Walking forward American Indian survivorship physical activity pilot
Daniel Petereit, MD, (Rapid City Regional Hospital)
This project will develop and evaluate a cell phone software application (app) designed to increase physical activity in American Indian (AI) cancer survivors from Pine Ridge and Rosebud Reservations. The RESEARCH QUESTION is, “Can a culturally appropriate cell phone app increase daily physical activity in American Indian (AI) cancer survivors living in the Northern Plains?” The aims are to:
Aim 1. Develop a culturally appropriate cell phone app to increase physical activity among AI cancer survivors living in the Northern Plains.
Aim 2. Collect pilot data to evaluate the usability and effectiveness of the app.
The intended population for this pilot is AI cancer survivors 21 and older, of both genders, who have been diagnosed with any type of cancer. Participants will be within 3 years of initial, recurrent or 2nd cancer diagnosis and self-report being able to take part in moderate physical activity. They may have co-morbidities such as diabetes and hypertension and must be able to understand, read and speak English.
The Project Team includes the investigators, Survivorship Navigators (SNs) and their supervisors. The team, in partnership with local Northern Plains AI cancer survivors, will develop content for the app that is culturally and geographically appropriate and promotes daily walking and stretch band exercises. A Community Advisory Committee from each Reservation will provide guidance and feedback on draft content and assess ease of use and cultural appropriateness of the preliminary app. A usability test on each Reservation will evaluate the app’s feasibility for use and the cultural and geographic appropriateness of the content.
The content will be integrated into a cell phone app created through the programming expertise of Ubicomp Lab, Marquette University. The app will (1) function as a pedometer; daily step counts will be uploaded to the Ubicomp secure server automatically; (2) provide mobile health (mHealth) text and video messages (the latter comprised of vignettes of Northern Plains cancer survivors providing messages about physical activity and QOL); (3) serve as an ejournal including ratings of physical activity, self-reports of symptoms and short phrases of attitudes and emotions related to taking part in physical activities and acceptability and usability of text messages and the overall app.
SNs will recruit potential participants, implement the informed consent process, collect the Symptom Distress Scale items, counsel participants on benefits of physical activity and teach them to use the app. They will meet individually with the survivor every 2 weeks during months 8, 9, and 10 (pilot implementation). This pilot will evaluate the cell phone app for effectiveness in increasing physical activity in 16 AI cancer survivors. The app will promote walking and stretch band exercises (both activities strongly supported by exercise physiologists). The primary outcomes of this pilot will be development of a cell phone app that that encourages physical activity and use of the app by AI cancer survivors. Results from this project will be used both for modifications to the app and in a subsequent comparative clinical trial intervention.
Culturally based curriculum, wicozani and suicidal ideation in Dakota youth
Heather Peters, PhD (University of Minnesota-Morris)
American Indian youth have the highest rate of suicide-related fatalities in Minnesota and in the nation (Center for Disease Control & Prevention, 2013; MN Department of Health, 2014). The overarching objective of this project is to increase wicozani (overall health) in Dakota youth. In the Dakota language, wicozani refers to the idea that physical, mental, emotional, and spiritual health are interdependent (Peters & Peterson, 2014a). Thus, from a Dakota epistemology, strong wicozani and suicidal ideation cannot co-exist. In order to increase wicozani and decrease suicidal ideation a cultural intervention (i.e., culturally-based curriculum) that creates visibility for Dakota youth in the educational system will be used. This visibility will increase Dakota youth’s sense of belonging and connectedness which will improve their wicozani (overall health) and decrease their suicidal ideation. The following aims will facilitate the achievement of this objective: 1) Train teachers to deliver and integrate the culturally-based curriculum within their current educational environments; 2) Pilot and edit the culturally-based curriculum; 3) Evaluate the influence of the culturally-based curriculum on Dakota youth’s sense of belonging (i.e., Sense of Belonging Instrument SOBI-Dakota, SOBI-Mainstream), connectedness (i.e., Awareness of Connectedness Scale), wicozani (i.e., Wicozani Self-Assessment), and suicide ideation (Suicide Ideation Question- JR, SIQ-JR). A within participant design along with a mixed methodology approach (i.e., quantitative and qualitative) will be used. The culturally-based curriculum will be introduced to Dakota youth who participate in Dakota Wicohan’s after school programs and in the 6th and 10th grade social studies classes at Redwood Area Schools. Dakota youth’s sense of belonging, connectedness, wicozani, and suicidal ideation will be measured prior to and following the cultural intervention. Dakota youth and their parents/caregivers will engage in talking circles both before and following the cultural intervention. During the talking circles participants will be asked questions regarding their thoughts, feelings and behaviors related to wicozani, sense of belonging, connectedness, and the visibility of Dakota people in the school system. This cultural intervention will impact the health of American Indian youth by providing teachers and communities with culturally-based curriculum that will increase visibility of American Indian youth and increase their sense of belonging, connectedness, and wicozani and thus address the health disparity concerning suicide. This cultural intervention is a community intervention in that in addition to Dakota youth, teachers and fellow non-native students will simultaneously be introduced to Dakota ways of knowledge. This approach will affect the social determinants of health because it works to improve the environment of Dakota youth. Additionally, this project will change how researchers approach suicide interventions. Instead of the primary focus being on suicidal ideation, the project takes a strength-based approach by focusing on sense of belonging, connectedness, and wicozani. These results will provide the data needed to approach Dakota communities in MN and those exiled Dakota communities in North and South Dakota.
Multilevel context of health-related quality of life in northern plains tribes
Ursula Running Bear, PhD (University of Colorado-Denver)
American Indians in South Dakota struggle with severe health disparities that are well documented and include high rates of death from alcohol, tuberculosis, injury and poisoning and high prevalence of mental health issues, suicide, and trauma. Using an American Indian Social Determinants of Health (SDOH) model to guide this secondary data analyses project, the relationship of the Short Form 36 (SF-36) to sociodemographic, historic indicators and trauma variables, physical and mental health as well as community contextual variables will be examined. The SF-36, a measure of physical and mental health disease burden, is commonly used yet little is known about its relationship to community contextual variables in American Indian communities. The specific aims of this application are to: 1) To explore the relationship of SES and historic indicators of SDOH with the SF-36 2) To investigate the relationships of physical and mental health indicators with the SF-36 3) To determine the community-level variation in the SF-36 within these reservation communities 4) Using multilevel techniques, develop models of the SF-36 that simultaneously account for individual and community level correlates. This secondary data analyses project uses data from the American Indian Service Utilization, Psychiatric Epidemiology, and Risk/Protective Factors Project collected in 1997-1999, as well as data that is linked to 2000 Census Block Group geographies. All data are de-identified. The sample includes enrolled members of two reservation populations located in South Dakota, aged 15-54 in 1997, and who lived on or within 20 miles of their reservations. Linear regression and nested linear modeling will be used to test hypotheses associated with these analyses.