Pamela Jumper Thurman

Native Americans and Alcohol: Past, Present, and Future

Native Americans have higher rates of alcohol use, frequency of use, and increased rates of fetal alcohol syndrome, compared with other ethnic groups (J. Hisnanick, 1992; P. A. May, 1996; J. M. Wallace et al., 2003). High prevalence rates of alcohol misuse among Native Americans must be understood in light of their unique history, which has resulted in trauma and exposure to many risk factors for problem alcohol use. Many risk factors have been identified in the general population; however, only some of these risk factors have been examined among Native American populations. The unique history and world view of Native Americans mean that, often, risk factors operate differently from the way they do in other populations. The authors discuss interventions and promising treatments.

American Indian Adolescent Drug Use and Socialization Characteristics A Cross-Cultural Comparison

The socialization variables of family strength, religious identification, school adjustment, family sanctions against drug use and peer associations correlate with youth drug abuse. A path model testing the relationships between these variables among Anglo youths has shown that peer drug associations mediate the influence of the other factors and that with minor exceptions peers are likely to be the dominating force in youth drug abuse. The current study applied the same path model to a group of American Indian youths and the findings were replicated with two important exceptions. Peer drug associations, although still dominant in the model, were not as highly correlated with drug use for Indian youths, and family sanctions against drugs had a direct influence on drug use in addition to an indirect influence. Differences in family dynamics among American Indian youths may account for the findings; they may associate more with and learn about drug use from same-aged siblings and other relatives in the extended family, and they may have a greater number of adult family figures to apply sanctions against drug use.

The Community Readiness Model: A Complementary Approach to Social Marketing

The Community Readiness Model is a theory-based model that is strategic in nature. It is designed both to assess and to build a community’s capacity to take action on social issues. It partners well with social marketing research by providing a framework for assessing the social contexts in which individual behaviour takes place and by measuring changes in readiness related to community-wide efforts. This article describes the theoretical roots of the model and describes how the model can be used as a tool for formative research, programme evaluation and as a catalyst for community mobilisation.

Community readiness: the journey to community healing.

Abstract Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific. culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

Prevalence of American Indian Adolescent Tobacco Use: 1993–2004

Tobacco use rates for American Indian adolescents are examined and compared to rates for non-Indian youth. The data are taken from an ongoing surveillance project of substance use among Indian youth and the Monitoring the Future Project for the years 1993 to 2004. Sample sizes are in the range of 14,000 to 17,000 for non-Indian youth and 600 to 2400 for Indian youth. Tobacco use is considerably higher for Indian youth; however, these rates are following the national trends of significant reductions over the past three years. Indian youth manifested a lower perception of harm from regular tobacco use, which may, in part, account for their higher levels of use. Indian females have had slightly higher rates of lifetime and daily smoking rates than males in the past but recent trends indicate a narrowing of this gap.

Disparities in young adolescent inhalant use by rurality, gender, and ethnicity.

Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individuals ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.

Disparities in Community Readiness for HIV/AIDS Prevention

HIV and AIDS as a community issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999–2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

Patterns of alcohol use among ethnic minority adolescent women.

There is agreement in the literature that women of the major ethnic groups in the United States have lower rates of alcohol use and suffer fewer alcohol-related problems than men. In adolescence, the highest rates of alcohol use are generally found among American Indians, followed in decreasing order by whites, Hispanics, African-Americans, and Asian-Americans. The role of sociocultural factors in alcohol use as found in the literature is discussed, including level of acculturation, generational status, culturally specific values and beliefs and peer influence. Lifetime and last 30-day prevalence, age of first time drunk, and peer sanction data from the 1989-93 database of The American Drug and Alcohol Survey are presented by gender and ethnicity for 8th and 12th graders. These data show similar rates of alcohol use by males and females in the 8th grade but more use by males in the 12th grade for all ethnicities except American Indians who live on reservations.

Community readiness: an effective model for tribal engagement in prevention of cardiovascular disease.

Significant health disparities exist among culturally diverse minority populations in the United States. The ways in which healthcare providers recognize and respond to this issue is critical. Methods must be effective, culturally appropriate, and engage the community if they are to be utilized, and they also need to be sustainable to make a significant impact. American Indians and Alaska Natives face many unique health disparities and challenges and they confront many barriers when seeking care and treatment. These obstacles make it essential for healthcare professionals to engage the community in the development of culturally appropriate strategies with which to address health issues. This article describes a community-based participatory approach that was executed successfully by the Choctaw Nation of Oklahoma. By utilizing the Community Readiness Model, it effectively built on the culture and resiliency that exists in each of 10 communities to more successfully implement community-responsive health prevention and treatment. This article discusses the experience of the Choctaw Nation in its assessment and engagement of the community in addressing cardiovascular disease. Data are presented that reflect the successful use of the Community Readiness Model and discussion is provided. This article emphasizes the use of an effective community-based participatory method, Community Readiness, that enabled the Choctaw Nation to make strong “inroads” into its respective service area through successful community engagement.

Proceedings “Strength-Based Models to Overcome Disparities: Bridging Research to Practice,” a conference held at the Tri-Ethnic Center for Prevention Research, Colorado State University, Fort Collins, CO, September 9 and 10, 2002 Culture and Health Disparities

This special issue is about health disparities. In order to have a disparity, there must be a difference in health or health behaviors between identified groups. But this fact immediately presents a difficult problem. Who are these groups, and how are the differences between the groups defined? It is essential to have a clear identification of the relevant groups, because the value in identifying and studying a health disparity lies in the ability to target interventions where they are most needed. There is, however, a danger in identifying groups because it is all too easy to slip into stereotypes, particularly the stereotype of race.