Native Health

Indigenous women experience disproportionately higher rates of adverse health outcomes. Few studies have explored the root of these problems or defined health and wellness from the perspectives of Indigenous women. Our objective was to elicit views on Indigenous women's health from women who are Indigenous and/or have experience working with Indigenous communities across Turtle Island and Hawai'i (e.g., United States). Informed by intersectionality as a social critical theory, we convened a workshop to engage in a co-creative consensus-building and expert decision process using design thinking. The two-day workshop embraced Indigenous values of land, sacred spaces, genealogy, family, rituals, and culture. Participants included United States-based Native and Indigenous women (n = 16) and allies (n = 7). Participants focused on answering key questions such as "What are priority areas for Indigenous women's health"? and "What are the key facilitators and barriers to improving Indigenous women's health"? Co-created priority lists for each of these topics were generated. Participants overwhelmingly reported satisfaction with the workshop process and emphasis on a strength-based, culturally driven approach to share their stories, which contextualized the ideas, concerns, and priorities of Indigenous women who self-reflected on their own health and wellness. Creating culturally safe spaces for Indigenous people to reflect on their own hopes for the future relates to the theme by describing a process to bridge traditional healing with modern-day practices to build pilina.

Native Americans serve in the U.S. military at the highest rate per capita of any ethnoracial group and have elevated rates of mental health (MH) difficulties compared to other ethnoracial groups, including posttraumatic stress disorder, alcohol use disorders, and suicide. Almost half of Native Veterans live in rural areas; rurality is associated with significant barriers to MH services. Engaging in outreach with Native Veterans is an important pathway for connecting them with MH care, but the outreach process and educational materials must be culturally aligned to be more effective. We collaborated with partners at a rural Department of Veterans Affairs medical center (VAMC) to develop and refine a process for co-creating MH-focused outreach materials that are culturally centered on the needs, preferences, and values of rural Native Veterans. Our model of Co-creating Outreach for Rural Native Veterans' Engagement (CORE) involves five key steps: building strong partnerships with rural VAMC partners (Connect), conducting a needs assessment to identify VAMC partners' and Native Veterans' unique needs (Learn), engaging in ongoing synchronous and asynchronous dialogue during iterative development of materials (Collaborate), piloting materials during outreach (Pilot), and refining materials based on Veteran and partner feedback (Re-evaluate). The process of developing culturally centered outreach materials should involve iterative refinement, partnerships and consultation with cultural experts, and strong relationships founded on respect, trust, and a commitment to bidirectional learning.

Meaningful and effective community engagement lies at the core of equity-centered research, which is a powerful tool for addressing health disparities in American Indian (AI) communities. It is essential for centering Indigenous wisdom as a source of solutions and disrupting Western-centric perspectives and inequitable and exclusionary research practices. This paper reports on lessons learned implementing an effectiveness trial of the Thiwáhe Glúwaš'akapi program (TG) program (translated as "sacred home in which families are made strong")-a family-based substance use prevention program-in a post-pandemic era with an American Indian reservation community that has confronted extreme challenges. We describe lessons in six areas (community engagement, study design, community workforce, participant engagement, retention, and data collection) that illustrate how conventional Western research practices were adapted in order to conduct authentic, equity-centered research. Key principles gleaned from those lessons are also discussed, including: (a) honoring partnerships and making study decisions collaboratively, (b) considering the implications of decisions for both the scientific value of the study and the community, (c) considering the health and well-being of community staff, (d) being flexible and responsive to changing needs, and (e) approaching work with communities through a strengths-based frame. Insight into the challenges encountered and the solutions developed in alignment with community partners and Indigenous wisdom may strengthen the work of other academic-community partnerships endeavoring to bring culturally relevant, evidence-informed prevention programming to Indigenous communities.

Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in genomics and health equity research to make recommendations and performed a review of current literature to identify the landscape of gaps and opportunities at the interface between human genomics and health equity research. This Perspective describes these findings and examines health equity within the context of human genomics and genomic medicine.

This Indigenous-led project aims to better understand historical and contemporary ways in which Alaska Native Peoples steward salmon and the values connected to salmon stewardship. Indigenous Peoples have stewarded Alaska lands and waters for thousands of years yet have been largely excluded from western science and management systems. In this project, we utilize a participatory approach that allows for the equitable valuing of ideas and knowledges to document the breadth and depth of Yup'ik and Athabascan knowledge and governance systems in southwestern Alaska. We reshape research methodologies by centering Indigenous frameworks and methodologies, including circle dialogues and multi-generational interviews led by Indigenous scholars and students in their home communities and regions. In this paper, we share the Yup'ik and Athabascan values, knowledge, management, and governance mechanisms that can improve the long-term sustainability and equity of Alaska salmon systems. This research elevates the voices of Alaska Native salmon stewards and experts from the Kuskokwim Bay and the Kuskokwim River. We elaborate on five key themes that emerged from this research, including traditional Indigenous ways of life, Indigenous stewardship, self-determination, food and livelihood sovereignty, and ecosystem changes, and identify a more equitable and sustainable path forward for salmon and people in Alaska.

This paper provides an overview of generative artificial intelligence (AI) and the possible implications in the delivery of mental health care. Generative AI is a powerful technology that is changing rapidly. As psychiatrists, it is important for us to understand generative AI technology and how it may impact our patients and our practice of medicine. This paper aims to build this understanding by focusing on GPT-4 and its potential impact on mental health care delivery. We first introduce key concepts and terminology describing how the technology works and various novel uses of it. We then dive into key considerations for GPT-4 and other large language models (LLMs) and wrap up with suggested future directions and initial guidance to the field.

The number of American Indian and Alaska Native (AI/AN) people living with dementia is expected to increase 5-fold by 2060. Social determinants of health may explain disparities in the incidence of Alzheimer disease (AD) but remain largely overlooked. We examined the time trend of AD mortality rates and associations of the percentage of AI/ANs, density of primary care physicians and neurologists, area deprivation index, rurality, and Indian Health Service region with AD mortality in 646 purchased/referred care delivery area counties. AD mortality rates significantly increased over time. Counties with higher concentrations of AI/AN people had lower AD mortality. More deprived counties had 34% higher AD mortality compared with less deprived counties. AD mortality was 20% lower in nonmetro counties than in metro counties. Findings have implications for prioritizing areas where more resources for AD care, education, or outreach are needed.