%0 Journal Article %J AIDS Educ Prev %D 2013 %T A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. %A Pearson, Cynthia R %A Walters, Karina L %A Simoni, Jane M %A Beltran, Ramona %A Nelson, Kimberly M %K Adolescent %K Adult %K Alaska %K Condoms %K Cross-Sectional Studies %K Health Knowledge, Attitudes, Practice %K HIV Infections %K HIV Seronegativity %K Homosexuality, Male %K Humans %K Indians, North American %K Male %K Middle Aged %K Risk Factors %K Risk Reduction Behavior %K Risk-Taking %K Sexual Partners %K Socioeconomic Factors %K Surveys and Questionnaires %K Truth Disclosure %K Unsafe Sex %K Urban Population %K Young Adult %X

American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.

%B AIDS Educ Prev %V 25 %P 25-37 %8 2013 Feb %G eng %N 1 %R 10.1521/aeap.2013.25.1.25 %0 Journal Article %J J Prim Prev %D 2012 %T Community-responsive interventions to reduce cardiovascular risk in American Indians. %A Jobe, Jared B %A Adams, Alexandra K %A Henderson, Jeffrey A %A Karanja, Njeri %A Lee, Elisa T %A Walters, Karina L %K Adult %K Cardiovascular Diseases %K Child %K Child, Preschool %K Consumer Participation %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Behavior %K Health Promotion %K Humans %K Indians, North American %K Infant %K Male %K Obesity %K Randomized Controlled Trials as Topic %K Risk Factors %K Smoking %K United States %X

American Indian and Alaska Native (AI/AN) populations bear a heavy burden of cardiovascular disease (CVD), and they have the highest rates of risk factors for CVD, such as cigarette smoking, obesity, and diabetes, of any U.S. population group. Yet, few randomized controlled trials have been launched to test potential preventive interventions in Indian Country. Five randomized controlled trials were initiated recently in AI/AN communities to test the effectiveness of interventions targeting adults and/or children to promote healthy behaviors that are known to impact biological CVD risk factors. This article provides a context for and an overview of these five trials. The high burden of CVD among AI/AN populations will worsen unless behaviors and lifestyles affecting CVD risk can be modified. These five trials, if successful, represent a starting point in addressing these significant health disparities.

%B J Prim Prev %V 33 %P 153-9 %8 2012 Aug %G eng %N 4 %R 10.1007/s10935-012-0277-9 %0 Journal Article %J Nurs Inq %D 2012 %T Finding middle ground: negotiating university and tribal community interests in community-based participatory research. %A Mohammed, Selina A %A Walters, Karina L %A LaMarr, June %A Evans-Campbell, Teresa %A Fryberg, Sheryl %K Clinical Protocols %K Community Health Services %K Community-Based Participatory Research %K Cooperative Behavior %K Focus Groups %K Humans %K Indians, North American %K Negotiating %K Northwestern United States %K Qualitative Research %K United States %K Universities %X

Community-based participatory research (CBPR) has been hailed as an alternative approach to one-sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co-sharing, mutual benefit, and community capacity building, it is often challenging as well. In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group.

%B Nurs Inq %V 19 %P 116-27 %8 2012 Jun %G eng %N 2 %R 10.1111/j.1440-1800.2011.00557.x %0 Journal Article %J Am J Drug Alcohol Abuse %D 2012 %T Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives. %A Evans-Campbell, Teresa %A Walters, Karina L %A Pearson, Cynthia R %A Campbell, Christopher D %K Acculturation %K Adult %K Alaska %K Alcohol-Related Disorders %K Anxiety Disorders %K Cross-Sectional Studies %K Female %K Health Surveys %K Humans %K Indians, North American %K Inuits %K Male %K Mental Disorders %K Middle Aged %K Schools %K Stress Disorders, Post-Traumatic %K Substance-Related Disorders %K Suicidal Ideation %K Suicide, Attempted %K United States %K Urban Population %X

BACKGROUND: Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools.

OBJECTIVES: To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school.

METHOD: Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use.

RESULTS: Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others.

%B Am J Drug Alcohol Abuse %V 38 %P 421-7 %8 2012 Sep %G eng %N 5 %R 10.3109/00952990.2012.701358 %0 Journal Article %J J Prim Prev %D 2012 %T Project həli?dx(w)/Healthy Hearts Across Generations: development and evaluation design of a tribally based cardiovascular disease prevention intervention for American Indian families. %A Walters, Karina L %A LaMarr, June %A Levy, Rona L %A Pearson, Cynthia %A Maresca, Teresa %A Mohammed, Selina A %A Simoni, Jane M %A Evans-Campbell, Teresa %A Fredriksen-Goldsen, Karen %A Fryberg, Sheryl %A Jobe, Jared B %K Adolescent %K Adult %K Body Mass Index %K Cardiovascular Diseases %K Community-Based Participatory Research %K Community-Institutional Relations %K Cultural Competency %K Family Relations %K Humans %K Indians, North American %K Inuits %K Life Style %K Male %K Motivational Interviewing %K Northwestern United States %K Parents %K Risk Factors %K Young Adult %X

American Indian and Alaska Native (AIAN) populations are disproportionately at risk for cardiovascular disease (CVD), diabetes, and obesity, compared with the general US population. This article describes the həli?dx(w)/Healthy Hearts Across Generations project, an AIAN-run, tribally based randomized controlled trial (January 2010-June 2012) designed to evaluate a culturally appropriate CVD risk prevention program for AI parents residing in the Pacific Northwest of the United States. At-risk AIAN adults (n = 135) were randomly assigned to either a CVD prevention intervention arm or a comparison arm focusing on increasing family cohesiveness, communication, and connectedness. Both year-long conditions included 1 month of motivational interviewing counseling followed by personal coach contacts and family life-skills classes. Blood chemistry, blood pressure, body mass index, food intake, and physical activity were measured at baseline and at 4- and 12-month follow-up times.

%B J Prim Prev %V 33 %P 197-207 %8 2012 Aug %G eng %N 4 %R 10.1007/s10935-012-0274-z %0 Journal Article %J AIDS Patient Care STDS %D 2011 %T Buffering effects of general and medication-specific social support on the association between substance use and HIV medication adherence. %A Lehavot, Keren %A Huh, David %A Walters, Karina L %A King, Kevin M %A Andrasik, Michele P %A Simoni, Jane M %K Adult %K Anti-HIV Agents %K Antiretroviral Therapy, Highly Active %K Female %K HIV Infections %K Humans %K Male %K Middle Aged %K Patient Compliance %K Social Support %K Socioeconomic Factors %K Substance-Related Disorders %K Young Adult %X

The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.

%B AIDS Patient Care STDS %V 25 %P 181-9 %8 2011 Mar %G eng %N 3 %R 10.1089/apc.2010.0314 %0 Journal Article %J Ann Behav Med %D 2011 %T 'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. %A Nelson, Kimberly M %A Simoni, Jane M %A Pearson, Cynthia R %A Walters, Karina L %K Adult %K Alaska %K Attitude to Health %K Cognition %K Condoms %K Cross-Sectional Studies %K HIV Infections %K Homosexuality, Male %K Humans %K Indians, North American %K Male %K Middle Aged %K Multivariate Analysis %K Risk Factors %K Risk-Taking %K Sexual Partners %K Socioeconomic Factors %K Stress Disorders, Post-Traumatic %K Surveys and Questionnaires %K Unsafe Sex %K Young Adult %X

BACKGROUND: American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission.

PURPOSE: This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM.

METHODS: AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed.

RESULTS: Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both.

CONCLUSIONS: Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

%B Ann Behav Med %V 42 %P 370-80 %8 2011 Dec %G eng %N 3 %R 10.1007/s12160-011-9302-0 %0 Journal Article %J Womens Health Issues %D 2011 %T Keeping our hearts from touching the ground: HIV/AIDS in American Indian and Alaska Native women. %A Walters, Karina L %A Beltran, Ramona %A Evans-Campbell, Tessa %A Simoni, Jane M %K Acquired Immunodeficiency Syndrome %K Adaptation, Psychological %K Culture %K Epidemics %K Female %K HIV Infections %K Humans %K Indians, North American %K Inuits %K Male %K Rape %K Residence Characteristics %K Spouse Abuse %K Stress, Psychological %K Substance-Related Disorders %K United States %K Women's Health %X

HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse. The authors also outline multiple indicators of resiliency in AIAN communities and stress the need for HIV prevention interventions for AIAN women to capitalize on cultural and community strengths.

%B Womens Health Issues %V 21 %P S261-5 %8 2011 Nov %G eng %N 6 Suppl %R 10.1016/j.whi.2011.08.005 %0 Journal Article %J J Epidemiol Community Health %D 2010 %T Who, and what, causes health inequities? Reflections on emerging debates from an exploratory Latin American/North American workshop. %A Krieger, Nancy %A Alegría, Margarita %A Almeida-Filho, Naomar %A Barbosa da Silva, Jarbas %A Barreto, Maurício L %A Beckfield, Jason %A Berkman, Lisa %A Birn, Anne-Emanuelle %A Duncan, Bruce B %A Franco, Saul %A Garcia, Dolores Acevedo %A Gruskin, Sofia %A James, Sherman A %A Laurell, Asa Christina %A Schmidt, Maria Inês %A Walters, Karina L %K Health Priorities %K Healthcare Disparities %K Humans %K Latin America %K North America %K Politics %K Poverty %K Public Health %K Social Conditions %K Social Justice %K Warfare %B J Epidemiol Community Health %V 64 %P 747-9 %8 2010 Sep %G eng %N 9 %R 10.1136/jech.2009.106906