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Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic

Dr. Elizabeth D'Amico, UCLA Fielding School of Public Health professor of community health sciences, co-authored a research article in a special edition of the American Indian Culture and Research Journal, evaluating health disparities and risk factors in American Indian and Alaska Native adolescents and young adults.

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Date: 
Saturday, May 1, 2021
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Dr. Elizabeth D'Amico, UCLA Fielding School of Public Health professor of community health sciences, co-authored a research piece in a special edition of the American Indian Culture and Research Journal, evaluating health disparities and risk factors in American Indian and Alaska Native adolescents and young adults.

Background

The coronavirus (COVID-19) pandemic poses unprecedented challenges for individuals across the lifespan and these challenges are more pronounced for those who live with poverty and health inequities. American Indian and Alaska Native people have long been one of the highest risk racial/ethnic groups for health disparities, a consequence of sustained colonization and institutional racism, resulting in government oppression, forced displacement and assimilation, and intergenerational trauma. Policies enacted over decades have contributed to these disparities, including forced removal from American Indian and Alaska Native homelands, forced placement into boarding schools with the intent of assimilating American Indian and Alaska Native youth into mainstream society, and laws prohibiting American Indian and Alaska Native people from practicing their religious and spiritual ceremonies. For example, the Relocation Act of 1956 is one US law that many people believe contributed to numerous health disparities among urban American Indian and Alaska Native people. This act financed the relocation of American Indian individuals and families to job training centers in designated US cities. Instead of creating greater economic stability, large numbers of American Indian people who moved to urban areas became unemployed, homeless, and disconnected from their community-based support networks.

Methods

Participants in this COVID-19 study come from a sample of youth participating in a longitudinal survey study, “Native American Youth Sleep Health and Wellness (NAYSHAW), which involves quantitative and qualitative (i.e., in-depth interview) data to broaden our understanding of sleep and its role in health among urban American Indian and Alaska Native youth. All recruitment, data collection, and analytic procedures for both NAYSHAW and this COVID-19 study were approved by the RAND Institutional Review Board. In order to be eligible for NAYSHAW, youth had to either verbally self-identify as American Indian or Alaska Native, or be identified as American Indian or Alaska Native by a parent or community member; live in an urban community; and be in the age range of 12–16 at the time of their baseline survey (March 2018–March 2020). Excluded were adolescents with major neurologic conditions (including intellectual disability), chronic medical conditions (e.g., cancer, diabetes, cardiovascular disease), or diagnosis of sleep apnea or restless legs syndrome.

Findings

Youth who completed the survey ranged in age from twelve to sixteen (mean age fourteen), with 58 percent self-identifying as female. Although all youth had to either self-identify verbally as American Indian or Alaska Native, or be identified as American Indian or Alaska Native by a parent or community member, three youth did not self-identify as American Indian or Alaska Native on the survey. This is similar to what we have found in other work with urban Native teens where not all teens marked American Indian or Alaska Native on their survey. Most of the sample (48%) reported that their mother had some college or graduated from college, and 24 percent said that their father had some college or graduated from college.

Interpretation

Due to the rapid data collection timeframe for this study, both the survey and interview samples are relatively small. Given the remarkable circumstances of this pandemic, the team decided that having timely preliminary mixed-methods data on this understudied population was crucial to provide an understanding of how COVID-19 was affecting urban American Indian and Alaska Native teens. Second, teens come from urban areas in southern, central, and northern California, so their experiences may not be representative of urban Native adolescents elsewhere in the United States. Furthermore, data collection occurred between May to July 1, 2020, a period in which different areas in California were transitioning from mandated stay-at-home orders to somewhat less stringent orders, which may have introduced heterogeneity. Third, socially desirable response bias may be a concern with the type of self-reported survey data and interview methods utilized in this study. However, survey and interview findings align with previous research with urban American Indian/Alaska Native teens, for example, on sleep health, mental health, food insecurity, and participation in traditional practices. Fourth, we did not compare quantitative findings to pre-COVID-19 outcomes, and thus we do not know whether in this sample mental health, family cohesion, and other outcomes increased or decreased after COVID-19; however, given that we are continuing to follow this cohort, our future work will allow us to analyze outcomes longitudinally. Finally, we used a rapid assessment method to explore the qualitative data given the timeliness of the data, which precluded the calculation of important qualitative metrics, such as inter-rater reliability and saturation. However, more than half of the codes in this study mirrored codes we had deployed and rigorously assessed for reliability during a prior study. Also, the combined analysis and reporting of survey and interview findings was an effective way of validating qualitative codes against survey results. Finally, all interviewers received extensive training and support relating to interviewing methods, but some differences in style and rapport may have occurred.

Funding

National Institute on Minority Health and Health Disparities.

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