Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities
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Multilevel and community-level interventions that target the social determinants of health and ultimately health disparities are seldom conducted in Native American communities. To contextualize the importance of multilevel and community-level interventions, major contributors to and causes of health disparities in Native communities are highlighted. Among the many documented socioeconomic factors influencing health are poverty, low educational attainment, and lack of insurance. Well-recognized health disparities include obesity, diabetes, and hypertension. Selected challenges of implementing community-level and multilevel interventions in Native communities are summarized such as the shortage of high-quality population health data and validated measurement tools. To address the lack of multilevel and community-level interventions, the National Institutes of Health created the Intervention Research to Improve Native American Health (IRINAH) program which solicits proposals that develop, adapt, and test strategies to address these challenges and create interventions appropriate for Native populations. A discussion of the strategies that four of the IRINAH grantees are implementing underscores the importance of community-based participatory policy work, the development of new partnerships, and reconnection with cultural traditions. Based on the work of the nearly 20 IRINAH grantees, ameliorating the complex social determinants of health disparities among Native people will require (1) support for community-level and multilevel interventions that examine contemporary and historical factors that shape current conditions; (2) sustainability plans; (3) forefronting the most challenging issues; (4) financial resources and time to collaborate with tribal leaders; and (5) a solid evidence base.
KeywordsMultilevel, community-level interventions Indigenous Native American Health disparities Community-based participatory research
This Supplemental Issue of Prevention Science was supported through funds from the National Cancer Institute (NCI). The research projects in which the issue is based include 26 awards through PAR-11-346 and PAR-14-260, funded through the National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Dental and Craniofacial Research (NIDCR), National Institute on Drug Abuse (NIDA), National Institute of Environmental Health Sciences (NIEHS), National Institute of Mental Health (NIMH), National Institute of Nursing Research (NINR), Office of Behavioral and Social Sciences Research (OBSSR), and National Institute on Minority Health and Health Disparities (NIMHD). Support for this paper included grants from NHLBI (R01HL117729, Jernigan, PI); NIMHD (R01MD011266, Jernigan, PI); and NIAAA (R01AA022066, D’Amico, PI; R01 AA022068, Duran, PI).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The studies referenced in this article did not include animals.
Informed consent was obtained from all individual participants included in these studies.
- Blue Bird Jernigan, V., Huyser, K. R., Valdes, J., & Simonds, V. W. (2017a). Food insecurity among American Indians and Alaska Natives: A national profile using the current population survey–food security supplement. Journal of Hunger & Environmental Nutrition, 12, 1–10. https://doi.org/10.1080/19320248.2016.1227750.CrossRefGoogle Scholar
- Brockie, T. N., Heinzelmann, M., & Gill, J. (2013). A framework to examine the role of epigenetics in health disparities among Native Americans. Nursing Research and Practice, Dec.9th 2013.Google Scholar
- Cronce, J. M., & Larimer, M. E. (2011). Individual-focused approaches to the prevention of college student drinking. Alcohol Research & Health, 34, 210–221.Google Scholar
- Davis, J. D., & Keemer, K. (2002). A brief history of and future considerations for research in American Indian and Alaska Native Communities. In Work Group on American Indian Research and Program Evaluation Methodology Symposium. Available: http://www4.nau.edu/ihd/airrtc/pdfs/monograph.pdf.
- Dickerson, D. L., Brown, R. A., Johnson, C. L., Schweigman, K., & D’Amico, E. J. (2016). Integrating motivational interviewing and traditional practices to address alcohol and drug use among urban American Indian/Alaska Native youth. Journal of Substance Abuse Treatment, 65, 26–35.CrossRefGoogle Scholar
- Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (Eds.). (1999). Brief alcohol screening and intervention for college students (BASICS): A harm reduction approach. New York, NY: Guilford Press.Google Scholar
- Food First. (2002). Food sovereignty: A right for all. In Political Statement of the NGO/CSO Forum for Food Sovereignty (Vol. 14).Google Scholar
- Gittelsohn, J., & Rowan, M. (2011). Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions. The American Journal of Clinical Nutrition, 93(5), 1179S–1183S.Google Scholar
- Indian Affairs Laws and Treaties. (1953). Concurrent Resolution of the Eighty-Third Congress, First Session, 1953 Indians. Retrieved from http://digital.library.okstate.edu/kappler.
- Jernigan, V. B. B., Duran, B., Ahn, D., & Winkleby, M. (2010). Changing patterns in health behaviors and risk factors related to cardiovascular disease among American Indians and Alaska Natives. American Journal of Public Health, 100(4), 677–683.Google Scholar
- Jernigan, V. B. B., Wetherill, M., Hearod, J., Jacob, T., Salvatore, A. L., Cannady, T., ... & Wiley, A. (2017). Cardiovascular disease risk factors and health outcomes among American Indians in Oklahoma: The THRIVE study. Journal of Racial and Ethnic Health Disparities, 4(6), 1061–1068. Google Scholar
- McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education & Behavior, 15, 351–377.Google Scholar
- U. S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2015). Multi-level intervention research methods: Recommendations for targeting hard-to-reach, high-risk or vulnerable populations and communities. Retrieved from https://www.nhlbi.nih.gov/research/reports/intervention-recs-for-high-risk-populations.
- U.S. Census Bureau. (2015). American community survey. American Indian and Alaska Natives. Retrieved from https://www.census.gov/programs-surveys/acs/.
- U.S. Department of Agriculture. (2012). Food Distribution Program on Indian Reservations: Persons Participating. Retrieved from http://www.fns.usda.gov/pd/21irpart.htm.
- United States Department of Agriculture. (2017). Child and Adult Care Food Program (CACFP) Nutrition Standards for CACFP Meals and Snacks. Retrieved from https://www.fns.usda.gov/cacfp/mealsand-snacks.
- Wetherill, M., Cannady, T., & Grammar, M., et al. (2016). Adapting the Nutrition Environment Measures Survey (NEMS) to assess tribally owned convenience stores in rural American Indian communities: The THRIVE study. Paper presented at the American Public Health Association Annual Meeting, Denver, CO.Google Scholar
- Wetherill, M., Cannady, T., & Grammar, M., et al. (2018). Food choice considerations among American Indians living in rural Oklahoma: The THRIVE study. Appetite (In Press).Google Scholar