Development of a Substance
Abuse Prevention/Intervention
Program of Research Among
Native American Youth
John Lowe, RN,
PhD, FAAN
Florida Atlantic
University
(954) 236-1275
jlowe@fau.edu
10/19/12 2
Where did the
thoughts &
inspiration come
from?
10/19/12 4
Family
and
Social, Psychological and Economic Stressors:
Highly correlated with substance abuse among
Native Americans
Causes:
Historical Trauma
-- genetic memory
-- unresolved grief
-- soul wounding
Forced Removals
Boarding Schools
Destabilization of Families
Economic Disadvantages
Etc.
Health Disparities
Disparity and dispossession go
hand in hand. The massive
dispossession that removed
Native people from their ancestral
lands – not to mention genocide
and cultural eradication that
followed – can hardly be imagined
by most people. This
dispossession is at the root of our
health disparities .
Michael Bird, 2002
Former President of the Amer. Public Health Assoc.
Current Exec. Dir. Of National Native
Loss of culture has been the
primary cause of many of
Native American s existing
social problems, especially
those associated with alcohol
… methods to measure Native
American cultural beliefs and
values have not been well
developed .
Master s Thesis:
The Social Support that
Contributes to the Abstinence
from Substance Abuse After
Treatment Among Native
American Young Adults
Funded By:
Mennonite Central Committee
Community Grant
Findings
Cultural protective factors:
…relationships
…traditional beliefs
…respect
…etc.
Publications: Mennonite News
Cherokee Self-Reliance
The Cherokee Way
Mainstay
Ga Du Gi
5-Year Ethnographic Studies to
Define and Describe the Concept
§
Funded by SAMHSA EMF at the ANA
The model of Cherokee
Self
‑
Reliance is formed in a
circle indicating the circular
holistic worldview of Cherokee
culture. The outside circle is
green which symbolizes an
oak wreath. The orange inner
circle symbolizes the sacred
eternal fire. The live oak the
traditional principal hardwood
timber of the Cherokee people,
was used to kindle the sacred
fire. In connection with this
fire, the oak was a symbol of
strength and everlasting life.
These colors are used in the
seal of the Cherokee Nation.
The three interlocking circles
in intertwining, and interlacing
of all of the categories and
subcategories of the cultural
domain of Cherokee
Cherokee Self-
Reliance
Questionnaire
24 – item Likert scale
Test-retest reliability
coefficient alpha of .84
Derived from the Native group being studied Native in general
Derived from the Native
group being studied
The model of Cherokee
Self
‑
Reliance is formed in a circle
indicating the circular holistic
worldview of Cherokee culture. The
outside circle is green which
symbolizes an oak wreath. The
orange inner circle symbolizes the
sacred eternal fire. The live oak the
traditional principal hardwood
timber of the Cherokee people, was
used to kindle the sacred fire. In
connection with this fire, the oak
was a symbol of strength and
everlasting life. These colors are
used in the seal of the Cherokee
Nation. The three interlocking
circles in intertwining, and
interlacing of all of the categories
and subcategories of the cultural
domain of Cherokee Self
‑
Reliance.
MODEL DERIVED FROM A SPECIFIC NATIVE
GROUP
GENERALIZABLE NATIVE MODELS:
Indigenist Stress Coping Model
(Dr. Karina Walters)
Non-Native Specific Models:
Teen Intervention Project –
Cherokee (TIP-C)
A school – based intervention study conducted to intervene with
early substance abuse among Cherokee/Keetoowah teens
Funded By: National Institute on Alcohol Abuse and Alcoholism (NIH).
Minority Supplement to R01 AA10246-05S1 Wagner.
Endorsed By: Cherokee Nation Tribal School
United Keetoowah Band of Cherokee Indians
Oklahoma Public Schools
10 - week
group
counseling
session
conducted in
the traditional
talking circle
format
TIP-C
Student Manual
Contents of the TIP-C Group Sessions
• Substance Abuse Education: Students are educated about substance use, the
development of substance use problems, and the historical perspectives and trends of substance use/abuse of Native Americans.
• Recognition and Acknowledgement of Personal Substance Use Problems:
Students learn to connect current difficulties with substance use.
• Self-Monitoring: Students commit to reducing or eliminating their own use of
alcohol and other drugs. Cherokee traditions relating to being responsible, being disciplined, and being confident are introduced.
• Commitment Generation: Students commit to reducing or eliminating their alcohol
and other drug use.
• Identification of High-Risk Situations: Students identify high-risk situations for
substance use.
• Alternatives to Substance Use: Students develop alternative behaviors to alcohol
use, with emphasis on high-risk alcohol use situations. Cherokee traditional activities are introduced.
• Coping with Stress: Students learn to recognize stress and develop non-alcohol
use strategies for coping with stress. The Cherokee concept of self is discussed.
• Family Conflict Resolution: Students learn and rehearse ways to manage conflicts
within families. Traditional Cherokee family structures and roles are reviewed.
• Relationship Building: Students are given guidelines for initiating and developing
reciprocal relationships with others. Students are given the traditional Cherokee life-way of relationships (Ga Du Gi) within Cherokee tribal communities.
• Abstinence Violation Effect: To prevent relapse, students learn to anticipate and
cope with the negative emotional reaction that is likely to follow a slip.
• Practicing Resistance/Refusal: Students learn and rehearse ways to manage
peer-related change their alcohol use behaviors.
• Alcohol use situations: Students review the Cherokee way of being disciplined.
• Social Support: Students identify groups and individuals who will support their
Cherokee Self-Reliance
CSRQ
(N=108)
1= pre-intervention
2= immediate post
3= 90-day post
Estimated Marginal Means of MEASURE_1
SR 3 2 1 Es tim at ed M arg ina l M ea ns 120 110 100 90 80
Substance Abuse
DUSI-R
(N=108)
1= pre-intervention
2= immediate post
3= 90-day post
Estimated Marginal Means of MEASURE_1
DUSIR 3 2 1 Es tim ate d M arg ina l M ea ns 25 24 23 22 21 20
Stress
PSS
(N=108)
1= pre-intervention
2= immediate post
3= 90-day post
Estimated Marginal Means of MEASURE_1
STRESS 3 2 1 Es tim at ed M arg in al M ea ns 44.0 43.5 43.0 42.5 42.0 41.5 41.0
Other Studies Conducted to Inform
and Test Components of the Cultural
Intervention
Teen Talking Circle for
HIV/AIDS and HCV Prevention
(
Funded By: The Association of Nurses in AIDS Care
Bio Tech Research Grant)
(Endorsed By: United Keetoowah Band of Cherokee
Indians)
Native American Nursing
Conceptual Framework
(Funded By: Johnson & Johnson, Corp.)
(
Endorsed By: United Keetoowah Band of Cherokee
Indians)
Additional Research that has helped to inform
the Program of Research:
▪
The Transcultural Caring Experience of Nursing
Students working with Tribes in Oklahoma .
§
Nursing in the Native American Culture.
§
Native American Nurses Stories .
§
Contributing Factors to Substance Abuse Among
the Homeless .
Funded By: Florida Atlantic University Research Enhancement Grants,
Johnson and Johnson Corporation, and
Conceptual
Framework
•
Caring
•
Tradition
•
Respect
•
Connection
•
Holism
•
Trust
•
Spirituality
TRADITIONS Relationship Respect Wisdom Values RESP ECT Relationship Honor Identity Strength CONNECTION Relationship Foundation TRUS T Relationship Presence Respect SPIRITUALITY Relationship Unity Honor Balance Healing NURSING IN NATIVE AMERICAN CULTURE HOLIS M Balance Cultura l Relationship CARING Health Relationship Holism Knowledge
Model of the dimensions and characteristics of
Nursing in the American culture
Expansion of the Self-Reliance Model with other
Native American Tribes
Community Partnership to
Affect Cherokee-Keetoowah
Adolescent Substance
Abuse
Funded By: The National Institute of Drug Abuse (NIH) R01 DA021714-01A2
Endorsed By: United Keetoowah Band of Cherokee Indians
COMMUNITY-BASED
PARTICIPATORY
RESEARCH (CBPR)
Stringer (1999) – CBPR favors participatory processes that
enable people to thoughtfully evaluate their situation and
determine solutions that fit their problems
…
which
demand consideration of the cultural context.
The core quality of CBPR is community-researcher
engagement for all phases with the underlying intention of
building community capacity and improving community
health.
a.
Create a community partnership steering committee;
b.
Assess the Cherokee-Keetoowah community needs
regarding substance abuse;
c. Partner with the Cherokee-Keetoowah community to
create culturally competent intervention materials and
select culturally appropriate outcome measures;
d. Evaluate the difference in substance abuse, Cherokee
self-reliance, and stress for Cherokee-Keetoowah adolescents
who receive the culturally competent intervention and
those who receive standard substance abuse education.
Specific Aims
Three Phases:
1.
Look – the researcher engages with
the community to clearly articulate the
problem, as it exists within the
community context.
2.
Think – community stakeholders
views are synthesized to create an
inclusive perspective of the problem,
which can be addressed with action.
3.
Act – goals, objectives and tasks are
identified and community stakeholders
are engaged in the process of affecting
the change.
BaselinePost-intervention3-mon follow-up TSSS CTC 23.94 (19.31) 16.19 (11.91) 10.91 (10.11) SE 25.43 (20.08) 27.33 (23.32) 27.18 (27.21) GLPI CTC 11.84 (8.98) 8.99 (6.64) 6.16 (5.58) IBS CTC 4.46 (4.60) 2.89 (3.14) 1.84 (2.72) SE 5.69 (4.79) 5.52 (5.06) 5.46 (5.71) EBS CTC 4.95 (3.83) 3.39 (3.61) 2.26 (3.11) SE 5.63 (4.48) 5.76 (5.14) 5.22 (5.32) SPS CTC 2.71 (4.47) 1.26 (2.48) .65 (1.59) SE 2.44 (4.42) 3.77 (5.65) 3.46 (5.51) SR CTC 89.5 (15.69) 93.07 (16.23) 100.53 (9.98) SE 88.77 (17.03) 85.71 (19.83) 85.18 (19.27)
GAIN-Q scores across time and group
N=187
Baseline
Post-intervention
3-mon follow-up
TSSS CTC 23.94 (19.31)
16.19 (11.91)
10.91 (10.11)
SE
25.43 (20.08)
27.33 (23.32)
27.18 (27.21)
GLPI CTC 11.84 (8.98)
8.99 (6.64)
6.16 (5.58)
SE
11.73 (8.84)
12.29 (9.93)
13.18 (12.04)
IBS
CTC 4.46 (4.60)
2.89 (3.14)
1.84 (2.72)
SE
5.69 (4.79)
5.52 (5.06)
5.46 (5.71)
EBS
CTC 4.95 (3.83)
3.39 (3.61)
2.26 (3.11)
SE
5.63 (4.48)
5.76 (5.14)
5.22 (5.32)
SPS
CTC 2.71 (4.47)
1.26 (2.48)
.65 (1.59)
SE
2.44 (4.42)
3.77 (5.65)
3.46 (5.51)
SR
CTC 89.5 (15.69)
93.07 (16.23)
100.53 (9.98)
SE
88.77 (17.03)
85.71 (19.83)
85.18 (19.27)
Publications:
Lowe, J. & Struthers, R. (2001). A Conceptual Framework: Nursing in the Native American Culture.
Journal of Nursing Scholarship, Third Quarter, 33 (3): 279-283.
Lowe, J. (2002). Cherokee Self-Reliance. Journal of Transcultural Nursing, 13 (4):287-295.
Struthers, R. & Lowe, J. (2003). Nursing in the Native American Culture and Historical Trauma. Issues in
Mental Health Nursing, 24 (3): 257-272.
Lowe, J. (2003). The Self-Reliance of the Cherokee Adolescent Male. Journal of Addictions Nursing, 14: 209-214.
Lowe, J. (2002). Balance and Harmony Through Connectedness: The Intention of Native American Nurses. Holistic Nursing Practice, 16 (4):4-11.
Lowe, J. (2004). Contributing Author. Circle of Harmony. National Native American AIDS Prevention Center. Oakland, CA.
Lowe, J. Featured Interview. Healing a Wounded Past. Minority Nurse, Spring 2004, 32-37.
Lowe, J. (2005). Being Influenced: A Cherokee Way of Mentoring. Journal of Cultural Diversity, 12 (2): 37- 49.
Lowe, J. (2005). Assessment. In Be Safe: A Guide for the Cultural Competent Health Care Treatment of
Native Americans Living with HIV/AIDS. National Minority AIDS Educ. Center: DC.
Lowe, J. (2008). Featured Interview. Lessons from My Father. Minority Nurse, Winter 2008, 40-44. Lowe, J. & Crow, K. (2009).Utilization of a Native American Nursing Conceptual Framework to Transform Nursing Education. International Journal for Human Caring, 13 (3):56- 64 .
Lowe, J. & Archibald, C. (2009). Cultural Diversity: The Intention of Nursing. Nursing Forum, 44 (1): 11-18.
Lowe, J. & Gibson, S. (2010). The Substance Use and Abuse Among A Homeless Population Journal of Addictions Nursing.
Lowe, J. & Nichols, LA. (2010). Utilization of a Native American Nursing Conceptual Framework: Implications for Practice and Research. Wicazo Sa Review Journal.
Patchell, B., Lowe, J., & Robbins, L. (2010). Cultural Tailoring of a Theoretical Framework used to Guide Native American Indian Adolescent's Substance Abuse Prevention/Intervention Programs. Journal
of Addictions Nursing.
Lowe, J. & Gibson, S. (2011). Reflections of a Homeless Population s Lived Experience with Substance Abuse. Journal of Community Health Nursing, 28 (2): 92-104
Lowe, J., et al (2011). Cultural Competencies for Graduate Nursing Education. Journal of Professional
Nursing, 27 (3): 133-139.
Lowe, J., Riggs, C., & Henson, J. (2011). Principles for Establishing Trust When Developing a Substance Abuse Intervention with a Native American Community. Journal of Creative Nursing, 17 (2): 68-73.
Presentations:
NANAINA SUMMITS
AMERICAN NURSES ASSOC. CONVENTIONS
AMERICAN ACADEMY OF NURSING CONFERENCES
INTERNATIONAL AIDS CONFERENCE
INTERNATIONAL SIGMA THETA TAU CONFERENCES
NATIONAL NATIVE AMERICAN NURSING EDUCATION CONFERENCES
NATIONAL CONGRESS ON THE STATE OF THE SCIENCE IN NURSING
RESEARCH CONFERENCES
SUMMIT ON AMERICAN INDIAN HEALTH CARE
NATIONAL INSTITUTUES OF HEALTH CONFERENCES
VETERANS ADMINISTRATION RESEARCH CONFERENCES
ALL THINGS ARE CONNECTED NATIVE AMERICAN/ALASKAN NATIVE
SUBSTANCE ABUSE, HIV/AIDS, AND DIABETES CONFERENCE
GATHERING OUR WISDOM CONFERENCE
EMBRACING OUR TRADITIONS CONFERENCE
TRANSCULTURAL NURSING CONFERENCES
FLORIDA NURSES ASSOCIATION CONFERENCES
INTERNATIONAL RESEARCH CONFERENCES
SOCIETY OF PREVENTION RESEARCH CONFERENCE
ETC.
Testing A Substance Abuse
Prevention for
Cherokee-Keetoowah
Early Adolescents
Funded By: The National Institute of Drug Abuse (NIH)
R34DA029724-01A1
Brief Intervention for Substance
Using Native Youth
SACRED
CONNECTIONS
(
Spiritual Attention Creates Responsible Destiny
)
Lowe & Wagner, Co-PIs
Funded By: The National Institute of Drug Abuse (NIH)
1R01DA029779-01A1
42
