Skip to main content

Advertisement

SpringerLink
Log in

Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Blue Bird Jernigan, V., Salvatore, A. L., Styne, D. M., & Winkleby, M. (2011). Addressing food insecurity in a Native American reservation using community-based participatory research. Health Education Research, 27, 645–655.

    Article  Google Scholar 

  • Blue Bird Jernigan, V., Peercy, M., Branam, D., Saunkeah, B., Wharton, D., Winkleby, M., et al. (2015). Beyond health equity: Achieving wellness within American Indian and Alaska Native communities. American Journal of Public Health, 105, S376–S379.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Blue Bird Jernigan, V., Wetherill, M. S., Hearod, J., Jacob, T., Salvatore, A. L., Cannady, T., & Buchwald, D. (2017b). Food insecurity and chronic diseases among American Indians in rural Oklahoma: The THRIVE study. American Journal of Public Health, 107, 441–446.

    Article  Google 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.

  • Brown, R. A., Dickerson, D. L., & D’Amico, E. J. (2016). Cultural identity among urban American Indian/Alaska native youth: Implications for alcohol and drug use. Prevention Science, 17, 852–861.

    Article  Google Scholar 

  • Charns, M. P., Foster, M. K., Alligood, E. C., Benzer, J. K., Burgess Jr., J. F., Li, D., et al. (2012). Multilevel interventions: Measurement and measures. Journal of the National Cancer Institute Monographs, 2012, 67–77.

    Article  Google Scholar 

  • Costa, F. M., Jessor, R., & Turbin, M. S. (1999). Transition into adolescent problem drinking: The role of psychosocial risk and protective factors. Journal of Studies on Alcohol, 60, 480–490.

    Article  CAS  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.

    Article  Google Scholar 

  • Dillinger, T., Jett, S., Macri, M., & Grivetti, L. . (1999). Feast or famine? Supplemental food programs and their impact on two American Indian communities in California. International Journal of Food Sciences and Nutrition, 50, 173–187.

    Article  CAS  Google 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.

  • Duran, B., Oetzel, J., Lucero, J., Jiang, Y., Novins, D. K., Manson, S., & Beals, J. (2005). Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment. Journal of Consulting and Clinical Psychology, 73, 819.

    Article  Google Scholar 

  • Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104, S303–S311.

    Article  Google Scholar 

  • Food First. (2002). Food sovereignty: A right for all. In Political Statement of the NGO/CSO Forum for Food Sovereignty (Vol. 14).

  • 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.

  • 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.

  • 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.

  • Lock, K. (2000). Health impact assessment. BMJ [British Medical Journal], 320, 1395.

    Article  CAS  Google Scholar 

  • McKinnon, R., Reedy, J., Handy, S., & Rodgers, A. (2009). Measuring the food and physical activity environments shaping the research agenda. American Journal of Preventive Medicine, 36, S81–S85.

    Article  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.

    CAS  Google Scholar 

  • Rasmus, S. M., Charles, B., & Mohatt, G. V. (2014). Creating Qungasvik (a Yup’ik intervention “toolbox”): Case examples from a community-developed and culturally-driven intervention. American Journal of Community Psychology, 54, 140–152.

    Article  Google Scholar 

  • Rutman, S., Park, A., Castor, M., Taualii, M., & Forquera, R. (2008). Urban American Indian and Alaska Native youth: Youth risk behavior survey 1997–2003. Maternal and Child Health Journal, 12, 76.

    Article  Google Scholar 

  • Trickett, E. J. (2009). Multilevel community-based culturally situated interventions and community impact: An ecological perspective. American Journal of Community Psychology, 43, 257–266.

    Article  Google Scholar 

  • Trickett, E. J., Beehler, S., Deutsch, C., Green, L. W., Hawe, P., McLeroy, K., Miller, R. L., Rapkin, B. D., Schensul, J. J., Schulz, A. J., & Trimble, J. E. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419.

    Article  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.

  • Warne, D., & Frizzell, L. B. (2014). American Indian health policy: Historical trends and contemporary issues. American Journal of Public Health, 104, S263–S267.

    Article  Google Scholar 

  • 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.

  • 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).

  • Woolf, S. H., & Braveman, P. (2011). Where health disparities begin: The role of social and economic determinants—And why current policies may make matters worse. Health Affairs, 30, 1852–1859.

    Article  Google Scholar 

Download references

Funding

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).

Author information

Authors and Affiliations

  1. College of Public Health, University of Oklahoma Health Sciences Center, 4502 E 41st St, Tulsa, OK, 74135-2512, USA

    Valarie Blue Bird Jernigan

  2. RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA

    Elizabeth J. D’Amico

  3. University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA

    Bonnie Duran

  4. Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA

    Dedra Buchwald

Authors
  1. Valarie Blue Bird Jernigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth J. D’Amico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bonnie Duran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dedra Buchwald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Valarie Blue Bird Jernigan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed consent was obtained from all individual participants included in these studies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blue Bird Jernigan, V., D’Amico, E.J., Duran, B. et al. Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities. Prev Sci 21 (Suppl 1), 65–73 (2020). https://doi.org/10.1007/s11121-018-0916-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-018-0916-3

Keywords

Search

Navigation