Understanding Mental and Behavioral Health of American Indian Youth: An Application of the Social Convoy Model

Objective: The purpose of this dissertation was to examine three distinct, yet related studies. The primary focus of each chapter is the examination of mental and behavioral health among North American Indigenous (American Indian, Alaska Native, and Canadian First Nations) youth - motivated by relational perspectives. Method: Data for this dissertation came from baseline data of a larger randomized control trial of a culturally adapted evidence-based substance use prevention program among 375 youth and 304 caregivers across four reservations that share a similar language, history, and culture. Study 1 Results: The aim was to examine caregiver and youth agreement on internalizing and externalizing symptoms and identify unique predictors of agreement between youth and caregiver. This study shows that caregivers perceive significantly fewer internalizing symptoms compared to youth self-reports. Externalizing problems, were not significantly different between caregivers and youth. Diverging patterns are found that significantly reduce disagreement for internalizing compared to externalizing. Study 2 Results: The aim was to examine the role of sibling influence on problem behavior. Using a dyadic approach, bivariate analyses as well as actor-partner interdependence models (APIM) were conducted. Correlations suggest self-reported happiness with female caregiver is associated with externalizing behavior. Older siblings showed significant within group differences for externalizing problem behavior scores based on caregiver education level–caregivers with college degree or higher indicating the highest average externalizing scores relative to other education categories. No sibling/actor influences were noted in the API Models. Study 3 Results: The purpose of this study was to explore problem behavior among Indigenous youth using individual social convoy characteristics as predictors of externalizing behavior. Consistent with the extant literature, females, when compared to male counterparts, had significantly lower externalizing problem behavior. Self-reported mastery remains significant in multivariate regression analyses. Interaction between network size and being connected to a caregiver in the networks is also a significant predictor of externalizing behavior. Conclusion: These three studies individually and collectively demonstrate the benefits of taking a relational approach to understand problem behaviors among Indigenous youth. Further, this dissertation fosters support for prevention models that aim to reduce mental and behavioral health problems in relational contexts. Advisors: Kirk Dombrowski and Dan Hoy

A method for assessing the success and failure of community-level interventions in the presence of network diffusion, social reinforcement, and related social effects

Prevention and intervention work done within community settings often face unique analytic challenges for rigorous evaluations. Since community prevention work (often geographically isolated) cannot be controlled in the same way other prevention programs and these communities have an increased level of interpersonal interactions, rigorous evaluations are needed. Even when the `gold standard' randomized control trials are implemented within community intervention work, the threats to internal validity can be called into question given informal social spread of information in closed network settings. A new prevention evaluation method is presented here to disentangle the social influences assumed to influence prevention effects within communities. We formally introduce the method and it's utility for a suicide prevention program implemented in several Alaska Native villages. The results show promise to explore eight sociological measures of intervention effects in the face of social diffusion, social reinforcement, and direct treatment. Policy and research implication are discussed.Comment: 18 pages, 5 figure

Understanding Mental and Behavioral Health of American Indian Youth: An Application of the Social Convoy Model

Objective: The purpose of this dissertation was to examine three distinct, yet related studies. The primary focus of each chapter is the examination of mental and behavioral health among North American Indigenous (American Indian, Alaska Native, and Canadian First Nations) youth - motivated by relational perspectives. Method: Data for this dissertation came from baseline data of a larger randomized control trial of a culturally adapted evidence-based substance use prevention program among 375 youth and 304 caregivers across four reservations that share a similar language, history, and culture. Study 1 Results: The aim was to examine caregiver and youth agreement on internalizing and externalizing symptoms and identify unique predictors of agreement between youth and caregiver. This study shows that caregivers perceive significantly fewer internalizing symptoms compared to youth self-reports. Externalizing problems, were not significantly different between caregivers and youth. Diverging patterns are found that significantly reduce disagreement for internalizing compared to externalizing. Study 2 Results: The aim was to examine the role of sibling influence on problem behavior. Using a dyadic approach, bivariate analyses as well as actor-partner interdependence models (APIM) were conducted. Correlations suggest self-reported happiness with female caregiver is associated with externalizing behavior. Older siblings showed significant within group differences for externalizing problem behavior scores based on caregiver education level–caregivers with college degree or higher indicating the highest average externalizing scores relative to other education categories. No sibling/actor influences were noted in the API Models. Study 3 Results: The purpose of this study was to explore problem behavior among Indigenous youth using individual social convoy characteristics as predictors of externalizing behavior. Consistent with the extant literature, females, when compared to male counterparts, had significantly lower externalizing problem behavior. Self-reported mastery remains significant in multivariate regression analyses. Interaction between network size and being connected to a caregiver in the networks is also a significant predictor of externalizing behavior. Conclusion: These three studies individually and collectively demonstrate the benefits of taking a relational approach to understand problem behaviors among Indigenous youth. Further, this dissertation fosters support for prevention models that aim to reduce mental and behavioral health problems in relational contexts. Advisors: Kirk Dombrowski and Dan Hoy

Understanding Mental and Behavioral Health of American Indian Youth: An Application of the Social Convoy Model

Objective: The purpose of this dissertation was to examine three distinct, yet related studies. The primary focus of each chapter is the examination of mental and behavioral health among North American Indigenous (American Indian, Alaska Native, and Canadian First Nations) youth - motivated by relational perspectives. Method: Data for this dissertation came from baseline data of a larger randomized control trial of a culturally adapted evidence-based substance use prevention program among 375 youth and 304 caregivers across four reservations that share a similar language, history, and culture. Study 1 Results: The aim was to examine caregiver and youth agreement on internalizing and externalizing symptoms and identify unique predictors of agreement between youth and caregiver. This study shows that caregivers perceive significantly fewer internalizing symptoms compared to youth self-reports. Externalizing problems, were not significantly different between caregivers and youth. Diverging patterns are found that significantly reduce disagreement for internalizing compared to externalizing. Study 2 Results: The aim was to examine the role of sibling influence on problem behavior. Using a dyadic approach, bivariate analyses as well as actor-partner interdependence models (APIM) were conducted. Correlations suggest self-reported happiness with female caregiver is associated with externalizing behavior. Older siblings showed significant within group differences for externalizing problem behavior scores based on caregiver education level–caregivers with college degree or higher indicating the highest average externalizing scores relative to other education categories. No sibling/actor influences were noted in the API Models. Study 3 Results: The purpose of this study was to explore problem behavior among Indigenous youth using individual social convoy characteristics as predictors of externalizing behavior. Consistent with the extant literature, females, when compared to male counterparts, had significantly lower externalizing problem behavior. Self-reported mastery remains significant in multivariate regression analyses. Interaction between network size and being connected to a caregiver in the networks is also a significant predictor of externalizing behavior. Conclusion: These three studies individually and collectively demonstrate the benefits of taking a relational approach to understand problem behaviors among Indigenous youth. Further, this dissertation fosters support for prevention models that aim to reduce mental and behavioral health problems in relational contexts

Understanding Mental and Behavioral Health of American Indian Youth: An Application of the Social Convoy Model

Objective: The purpose of this dissertation was to examine three distinct, yet related studies. The primary focus of each chapter is the examination of mental and behavioral health among North American Indigenous (American Indian, Alaska Native, and Canadian First Nations) youth - motivated by relational perspectives. Method: Data for this dissertation came from baseline data of a larger randomized control trial of a culturally adapted evidence-based substance use prevention program among 375 youth and 304 caregivers across four reservations that share a similar language, history, and culture. Study 1 Results: The aim was to examine caregiver and youth agreement on internalizing and externalizing symptoms and identify unique predictors of agreement between youth and caregiver. This study shows that caregivers perceive significantly fewer internalizing symptoms compared to youth self-reports. Externalizing problems, were not significantly different between caregivers and youth. Diverging patterns are found that significantly reduce disagreement for internalizing compared to externalizing. Study 2 Results: The aim was to examine the role of sibling influence on problem behavior. Using a dyadic approach, bivariate analyses as well as actor-partner interdependence models (APIM) were conducted. Correlations suggest self-reported happiness with female caregiver is associated with externalizing behavior. Older siblings showed significant within group differences for externalizing problem behavior scores based on caregiver education level–caregivers with college degree or higher indicating the highest average externalizing scores relative to other education categories. No sibling/actor influences were noted in the API Models. Study 3 Results: The purpose of this study was to explore problem behavior among Indigenous youth using individual social convoy characteristics as predictors of externalizing behavior. Consistent with the extant literature, females, when compared to male counterparts, had significantly lower externalizing problem behavior. Self-reported mastery remains significant in multivariate regression analyses. Interaction between network size and being connected to a caregiver in the networks is also a significant predictor of externalizing behavior. Conclusion: These three studies individually and collectively demonstrate the benefits of taking a relational approach to understand problem behaviors among Indigenous youth. Further, this dissertation fosters support for prevention models that aim to reduce mental and behavioral health problems in relational contexts

Adult-Onset and Adolescent-Limited Suicidal Ideation: A Developmental Approach to Suicide

Suicidal thoughts and actions have typically been studied from an eventsbased perspective. Some emerging studies, however, have begun to examine suicide and related behaviors through a longitudinal perspective, specifically focusing on establishing trajectories of suicidal behavior. In general, this work produces three-class trajectories of suicide attempts among adolescents, including groups such as: (1) no or low suicidal behavior; (2) moderate suicidal behavior; and (3) high suicidal behavior. Less is known about potential trajectory patterns of suicidal ideation associated with later stages of the life course. Moreover, identifying a low-, moderate-, and high-risk group does not inform the developmental processes that create time-varying risks for suicidal thoughts and attempts. Using data from Add Health, we estimate growth mixture models to explore suicidal ideation trajectories from early adolescence to early adulthood and explore how trajectories inform the link between suicidal ideation and attempts. Our results are among the first to indicate that there are four developmental trajectories associated with suicidal ideation including low-risk, high-risk, adolescent- limited, and adult-onset trajectories of suicidal ideation. Additionally, we find that suicide attempts were more likely among those in high-risk and adult-onset trajectories, compared to those in low-risk trajectories. Considering these findings identify specific time periods in the life course that are associated with suicidal ideation and attempts, our research uncovers another clear opportunity for intentional intervention efforts within the life course. To this end, prevention implications and suggestions for future research are discussed