Examining the role of culture and cultural perceptions of aging and dementia in the recognition, diagnosis, and treatment of age-related cognitive impairment remains an understudied area of clinical neuropsychology. This paper describes a qualitative study based on a series of key informant group interviews with an Aboriginal Grandmothers Group in the province of Saskatchewan. Thematic analysis was employed in an exploration of Aboriginal perceptions of normal aging and dementia and an investigation of issues related to the development of culturally appropriate assessment techniques. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system: (1) cognitive and behavioural changes were perceived as a normal expectation of the aging process and a circular conception of the lifespan was identified, with aging seen as going back "back to the baby stage", (2) a "big change in culture" was linked by Grandmothers to Aboriginal health, illness (including dementia), and changes in the normal aging process, and (3) the importance of culturally grounded healthcare both related to review of assessment tools, but also within the context of a more general discussion of experiences with the healthcare system. Themes of sociocultural changes leading to lifestyle changes and disruption of the family unit and community caregiving practices, and viewing memory loss and behavioural changes as a normal part of the aging process were consistent with previous work with ethnic minorities. This research points to the need to understand Aboriginal perceptions of aging and dementia in informing appropriate assessment and treatment of age-related cognitive impairment and dementia in Aboriginal seniors.
Sustainable food systems are those in which diverse foods are produced in close proximity to a market. A dynamic, adaptive knowledge base that is grounded in local culture and geography and connected to outside knowledge resources is essential for such food systems to thrive. Sustainable food systems are particularly important to remote and Aboriginal communities, where extensive transportation makes food expensive and of poorer nutritional value. The Learning Garden program was developed and run with two First Nation communities in northwestern Ontario. With this program, the team adopted a holistic and experiential model of learning to begin rebuilding a knowledge base that would support a sustainable local food system. The program involved a series of workshops held in each community and facilitated by a community-based coordinator. Topics included cultivated gardening and forest foods. Results of survey data collected from 20 Aboriginal workshop participants are presented, revealing a moderate to low level of baseline knowledge of the traditional food system, and a reliance on the mainstream food system that is supported by food values that place convenience, ease, and price above the localness or cultural connectedness of the food. Preliminary findings from qualitative data are also presented on the process of learning that occurred in the program and some of the insights we have gained that are relevant to future adaptations of this program.
American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, P.O. Box 6508, Mailstop F800, Aurora, Colorado 80045, USA. email@example.com
OBJECTIVE: Anthropologists with an interest in American Indian alcohol use have long held that how native people drink has been conditioned by aspects of the social organization of their societies prior to the disruptive influences of European colonialism. Our goal in this article was to explicitly test the importance of these factors in four contemporary American Indian cultural groups. METHOD: Using data on adolescent alcohol use drawn from the first full wave of the longitudinal Voices of Indian Teens Project (N = 1,651, 51% female), we tested whether patterns of quantity-frequency of alcohol use and the negative consequences of alcohol use predicted by social organzational variables were found among contemporary adolescents and, subsequently, whether these differences persisted when other, more proximal, variables were included. RESULTS: Cultural differences appeared to account for a small percentage of the variance in both quantity-frequency of alcohol use and negative consequences in the initial steps of our analyses, but the pattern in these data was not consistent with the predictions of existing theories regarding aboriginal social organization. Moreover, these cultural differences were no longer significant in the final step of our analyses, suggesting that the cultural differences that did exist were better explained by other factors, at least among these adolescents. CONCLUSIONS: Although these analyses did not indicate that culture was irrelevant in understanding adolescent alcohol use in American Indian communities, classic formulations of these effects were of limited utility in understanding the experiences of contemporary American Indian adolescents.
Urbanization among Indigenous peoples is growing globally. This has implications for the assertion of Indigenous rights in urban areas, as rights are largely tied to land bases that generally lie outside of urban areas. Through their impacts on the broader social determinants of health, the links between Indigenous rights and urbanization may be related to health. Focusing on a Canadian example, this study explores relationships between Indigenous rights and urbanization, and the ways in which they are implicated in the health of urban Indigenous peoples living in Toronto, Canada. In-depth interviews focused on conceptions of and access to Aboriginal rights in the city, and perceived links with health, were conduced with 36 Aboriginal people who had moved to Toronto from a rural/reserve area. Participants conceived of Aboriginal rights largely as the rights to specific services/benefits and to respect for Aboriginal cultures/identities. There was a widespread perception among participants that these rights are not respected in Canada, and that this is heightened when living in an urban area. Disrespect for Aboriginal rights was perceived to negatively impact health by way of social determinants of health (e.g., psychosocial health impacts of discrimination experienced in Toronto). The paper discusses the results in the context of policy implications and future areas of research.
Centre for Behavioural Research and Program Evaluation, Lyle S Hallman Institute, Room 1717A, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1. firstname.lastname@example.org
To conduct an exploratory, comparative study of the utilisation and effectiveness of tobacco cessation quitlines among aboriginal and non-aboriginal Canadian smokers.
Population based quitlines that provide free cessation information, advice and counselling to Canadian smokers.
First time quitline callers, age 18 years of age and over, who called the quitline between August 2001 and December 2005 and who completed the evaluation and provided data on their ethnic status (n = 7082).
Demographic characteristics and tobacco behaviours of participants at intake and follow-up; reasons for calling; actions taken toward quitting, and 6-month follow-up quit rates.
7% of evaluation participants in the time period reported aboriginal origins. Aboriginal participants were younger than non-aboriginals but had similar smoking status and level of addiction at intake. Concern about future health and current health problems were the most common reasons aboriginal participants called. Six months after intake aboriginals and non-aboriginals had taken similar actions with 57% making a 24-hour quit attempt. Quit rates were higher for aboriginals than non-aboriginals, particularly for men. The 6-month prolonged abstinence rate for aboriginal men was 16.7% compared with 7.2% for aboriginal women and 9.4% and 8.3% for non-aboriginal men and women, respectively.
This exploratory analysis showed that even without targeted promotion, aboriginal smokers do call Canadian quitlines, primarily for health related reasons. We also showed that the quitlines are effective at helping them to quit. As a population focused intervention, quitlines can reach a large proportion of smokers in a cost efficient manner. In aboriginal communities where smoking rates exceed 50% and multiple health risks and chronic diseases already exist, eliminating non-ceremonial tobacco use must be a priority. Our results, although exploratory, suggest quitlines can be an effective addition to aboriginal tobacco cessation strategies.
Cites: N Engl J Med. 2002 Oct 3;347(14):1087-9312362011
Child abuse and neglect is of growing concern in many American Indian and Alaska Native communities. The present paper represents one attempt to add to the existing, albeit sparse, knowledge base concerning the abuse and neglect of American Indian children. It reports the results of a survey of federal human service providers in which the subject of child abuse and neglect in Indian communities figured prominently. The study took place at several locations in Arizona and New Mexico. Data were obtained using the key-informant method from 55 federal service providers who identified 1,155 children, from birth to 21 years for inclusion in the survey. Children were included if they were currently in mental health treatment, if they were in need of mental health treatment, or if they were known to have been abused or neglected. Particular emphasis was given in the data collection to abuse- and neglect-related factors such as living arrangements, familial disruption, psychiatric symptoms, substance abuse, and school adjustment. The patterns evident in this sample closely resemble those trends identified among abused and/or neglected children in the general population. Sixty-seven percent of the sample was described as neglected or abused. The presence of abuse and/or neglect was strongly related to severe levels of chaos in the family. Children who were described as both abused and neglected had more psychiatric symptoms, greater frequency of having run away or been expelled, and greater frequency of drug use.
STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.
Social-emotional competence may be a protective factor for academic achievement among American Indian and Alaska Native (AI/AN) students. This study used Fisher's r to Z transformations to test for group differences in the magnitude of relationships between social-emotional competence and achievement. Hierarchical linear modeling was used to determine the variance in academic achievement explained by student race, poverty, and social-emotional competence, and the schoolwide percentage of students by race. Data are from 335 students across 6 schools. This study suggests that promoting social-emotional competence among AI/AN students could be a strategy for reducing disparities in academic achievement and the consequences of these disparities.
Longstanding disparities in substance use disorders and treatment access exist among American Indians/Alaska Natives (AI/AN). Computerized, web-delivered interventions have potential to increase access to quality treatment and improve patient outcomes. Prior research supports the efficacy of a web-based version [therapeutic education system (TES)] of the community reinforcement approach to improve outcomes among outpatients in substance abuse treatment; however, TES has not been tested among AI/AN. The results from this mixed method acceptability study among a diverse sample of urban AI/AN (N = 40) show that TES was acceptable across seven indices (range 7.8-9.4 on 0-10 scales with 10 indicating highest acceptability). Qualitative interviews suggest adaptation specific to AI/AN culture could improve adoption. Additional efforts to adapt TES and conduct a larger effectiveness study are warranted.
Telepsychiatry differs from in-person treatment in terms of its delivery mechanism, and this dissimilarity may increase cultural differences between the provider and the patient. Because cultural competence and identification can impact patient satisfaction ratings, we wanted to explore whether cultural differences in our study population influenced telepsychiatric and in-person interviews. Here, we compared the acceptability of conducting psychiatric assessments with rural American Indian veterans by real-time videoconferencing versus inperson administration. The Structured Clinical Interview for DSM-IIIR (SCID) was given to participants both in person and by telehealth. A process measure was created to assess participants' responses to the interview type concerning the usability of the technology, the perceptions of the interviewee/interviewer interaction, the cultural competence of the interview, and satisfaction with the interview and the interview process. The process measure was administered to 53 American Indian Vietnam veterans both in-person and by real-time interactive videoconferencing. Mean responses were compared for each participant. Interviewers were also asked several of the same questions as the participants; answers were compared to the corresponding participant responses. Overall, telepsychiatry was well received and comparable in level of patient comfort, satisfaction, and cultural acceptance to in-person interviews. We also found evidence to suggest that interviewers sometimes interpreted participant satisfaction as significantly less favorable than the participants actually responded. Despite the potential of videoconferencing to increase cultural differences, we found that it is an acceptable means for psychiatric assessment of American Indian veterans and presents an opportunity to provide mental health services to a population that might otherwise not have access.