Suicide Ideation Amongst Adolescent American Indains in a Longitudinal Context

The objective of this study is to compare suicidal thoughts amongst American Indian/Alaskan Native\u27s (AI/AN) to a non-AI/AN comparison group, using data from the National Longitudinal Study of Adolescent Health, a nationally-representative, longitudinal study. At wave one a statistical difference is present between NA/AN and comparisons, but at wave four the difference is no longer significant. Using Agnew’s General Strain theory as a theoretical framework, factors that may contribute to these differences addressed in this study include: alcohol abuse, exposure to suicidal behavior of friends and family, depression, and weapon access. Implications for prevention and treatment are discussed

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

Chapter 10: Unintended Interviewer Bias in a Community-based Participatory Research Randomized Control Trial among American Indian Youth Appendix 10

Appendix 10A Analysis of Internalizing and Externalizing Subscales Table A10A.1: Linear Mixed-Effects Models Predicting Subscales of Internalizing Behavior Table A10A.2: Linear Mixed-Effects Models Predicting Subscales of Externalizing Behavio

Unintended Interviewer Bias in a Community-based Participatory Research Randomized Control Trial among American Indian Youth

Community-based participatory research (CBPR) projects often employ members of the host partner community to engage and assist with research projects. However, CBPR may also introduce bias to survey statistics when community partners work as interviewers for projects within their own communities. Here, the advantage of employing interviewers from the local community and region may lead to unintended bias when participants and interviewers know each other outside of the research project. In situations where a preexisting social relationship exists, there is a greater possibility of social desirability bias. This may be particularly true for sensitive issues where they may not wish for members of their community to learn something about themselves which would otherwise remain hidden or private. This paper examines three sources of potential interviewer effects upon measures of mental health and cultural engagement. Both are key outcomes of a random control trial intervention underway with American Indian youth living on or near reservations. Mental health is measured using the Achenbach System of Empirically Based Assessment (ASEBA) with a 107 item tool which gauges levels of externalizing and internalizing behavior among minors, as well as three subscales for internalizing behavior and two subscales for externalizing behavior. Cultural engagement is measured with an inventory of common local/regional cultural activities. Three interview/interviewer characteristics are assessed in this paper. The first is whether an interviewer reports knowing the participant very well or somewhat well compared to not knowing them at all. We find that participants who were known by the interviewer scored lower on the aggregate internalizing scale and in all three subscales than participants who were unknown to the interviewer. However, there was no effect upon either externalizing scores or reported cultural participation when the interviewer knew the participant. The second factor tested is whether the interviewer reported a third party present during the interview who was listening or taking part. Here we found that having a third party present was associated with lower scores on the somatic complaints subscale of the internalizing scale, but no other subscale or aggregate measures. The third interview factor tested is the interviewer’s assessment of whether the participant was open with their responses or not. Here we find participants who were rated as open, reported higher levels of cultural participation and lower values on the internalizing subscale that assess withdrawn characteristics. We found no difference in the externalizing scales or the aggregate internalizing scale. The effects of these associations upon study outcomes and their potential to shift the diagnostic criteria of the ASEBA are discussed in the full paper

Unintended Interviewer Bias in a Community-based Participatory Research Randomized Control Trial among American Indian Youth

Community-based participatory research (CBPR) projects often employ members of the host partner community to engage and assist with research projects. However, CBPR may also introduce bias to survey statistics when community partners work as interviewers for projects within their own communities. Here, the advantage of employing interviewers from the local community and region may lead to unintended bias when participants and interviewers know each other outside of the research project. In situations where a preexisting social relationship exists, there is a greater possibility of social desirability bias. This may be particularly true for sensitive issues where they may not wish for members of their community to learn something about themselves which would otherwise remain hidden or private. This paper examines three sources of potential interviewer effects upon measures of mental health and cultural engagement. Both are key outcomes of a random control trial intervention underway with American Indian youth living on or near reservations. Mental health is measured using the Achenbach System of Empirically Based Assessment (ASEBA) with a 107 item tool which gauges levels of externalizing and internalizing behavior among minors, as well as three subscales for internalizing behavior and two subscales for externalizing behavior. Cultural engagement is measured with an inventory of common local/regional cultural activities. Three interview/interviewer characteristics are assessed in this paper. The first is whether an interviewer reports knowing the participant very well or somewhat well compared to not knowing them at all. We find that participants who were known by the interviewer scored lower on the aggregate internalizing scale and in all three subscales than participants who were unknown to the interviewer. However, there was no effect upon either externalizing scores or reported cultural participation when the interviewer knew the participant. The second factor tested is whether the interviewer reported a third party present during the interview who was listening or taking part. Here we found that having a third party present was associated with lower scores on the somatic complaints subscale of the internalizing scale, but no other subscale or aggregate measures. The third interview factor tested is the interviewer’s assessment of whether the participant was open with their responses or not. Here we find participants who were rated as open, reported higher levels of cultural participation and lower values on the internalizing subscale that assess withdrawn characteristics. We found no difference in the externalizing scales or the aggregate internalizing scale. The effects of these associations upon study outcomes and their potential to shift the diagnostic criteria of the ASEBA are discussed in the full paper

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

Chapter 10: Unintended Interviewer Bias in a Community-based Participatory Research Randomized Control Trial among American Indian Youth Appendix 10

Appendix 10A Analysis of Internalizing and Externalizing Subscales Table A10A.1: Linear Mixed-Effects Models Predicting Subscales of Internalizing Behavior Table A10A.2: Linear Mixed-Effects Models Predicting Subscales of Externalizing Behavio

The Relationship between Survival Sex and Borderline Personality Disorder Symptoms in a High Risk Female Population

Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD symptomology and sexual history. Bivariate and multivariate analyses conducted in this study provided insights into the association of experiencing BPD symptoms and engaging in survival sex. Results indicate that some symptoms of BPD are robustly correlated with engaging in survival sex among homeless adult women. Implications for service agencies and others working with at-risk female populations are discussed

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