Physical and Mental Health

Due to cultural and geographic diversity of AI/ANs, tobacco use often varies widely by region and subgroup. However, lung cancer is the leading cause of cancer death among AI/ANs.⁵ AI/AN youth aged 12-17 have the highest prevalence of smoking compared with other racial and ethnic populations.⁶

Additionally, alcoholism mortality is 514 percent higher in the overall AI/AN population compared to the general population. More than 22 percent of AI/AN youth aged 12 and older report alcohol use, and more than 16 percent report binge drinking and other substance use issues. Increased methamphetamine use is also a concern among the AI/AN population.⁷

An example of a successful program focused on AI/AN youth with substance use issues is the Cherokee Talking Circle (CTC) of the United Keetowah Band of Cherokee Indians in Oklahoma. CTC is a culturally based intervention with the main goal of reducing substance abuse and with, “…abstinence [from substance use] as an ideal outcome.” The program includes Keetowah-Cherokee values and integrates the Cherokee concept of self-reliance and, “…their overall worldview that all things come together to form a whole.” In comparison with other standard substance abuse programming, CTC has been found to be significantly more effective in reducing substance use and other related problem behaviors among AI/AN youth.⁸

AI/AN youth have the highest suicide rate of any cultural or ethnic group in the United States.⁹ Compared to other racial/ethnic groups, the rate of suicide among AI/AN males aged 15-25 is four times higher and AI/AN females is up to 11 times higher.¹⁰ In the U.S., 11-20 percent of AI/AN youth report attempting suicide each year.¹¹

There are several federal cross-agency collaborations and resources that aim to promote effective suicide prevention efforts in AI/AN communities. The Substance Abuse and Mental Health Services Administration provides a comprehensive and user-friendly resource, Promoting Suicide Prevention Efforts in American Indian/Alaska Native Communities: A Cross-Agency Approach (PDF, 1 page), that details these efforts and includes telehealth resources and activities, and resources and tools.

An example of a program that is focused on suicide prevention is the American Indian Life Skills Development program, also known as Zuni Life Skills Development. The program is customized to AI/AN norms and values and was designed to reduce behavioral and cognitive factors associated with suicidal thinking and behavior. Program outcomes have shown that intervention students demonstrated significantly higher levels of suicide intervention skills and problem-solving skills than the non-intervention group.¹²

Injuries and violence are the leading causes of death of Native American children and youth, accounting for 75 percent of all deaths among one to 19 year olds. Injury mortality data from 1989 through 1998 for AI/AN youth show motor vehicle and pedestrian accidents and suicide were highest in deaths from injury among this group.¹³

AI/AN youth have the third highest birth rate in the U.S. Between 2005 and 2007, the birth rate among AI/AN teens increased 12 percent, more than twice the national increase and more than any other racial/ethnic group. While there is little information available about AI/AN youth on sexual behavior and contraception use, available data suggests AI/AN girls are more likely to engage in sexual intercourse before the age of 16 and less likely to have used contraception the last time they had sex compared to other teens.¹⁴

The Personal Responsibility Education Program (PREP) is a funding opportunity for Native American communities from the Family and Youth Services Bureau (FYSB). The grant program focuses on teen pregnancy prevention and is designed to help prepare young people in their transition to adulthood. PREP is based off of evidence-based interventions that have been shown to be effective in changing behavior. FYSB conducted public consultations with more than 150 people from more than 30 tribes and it was found that representatives strongly supported the design of programs at the local level, “where individual community needs and cultural values can be reflected.” By 2011 there were 16 tribal organizations that were implementing PREP in their communities. First year grantees were from: Alabama, Arizona, California, Michigan, North Dakota, New Mexico, Oklahoma, Oregon, and South Dakota.¹⁵

Poverty, poor education, and inequality, and movement from rural to urban environments are risk factors that impact trafficking for AI/AN youth. Each of these risks combine with other factors such as lack of adequate criminal justice infrastructure to meet the needs of Indian country and a scarcity of social services for victims makes addressing the problem especially daunting.

An evaluation of trafficking services for AI/AN girls and women at the Minnesota Indian Women’s Resource Center discovered four key lessons about working with this population.

1. Routinely asking AI/AN girls who are entering harm reduction programs if they have ever been involved in trading sex often opens up conversation about commercial sexual exploitation and trafficking.
2. Utilizing outreach efforts at schools to link at-risk girls to, “culturally grounded, trauma-centered, long-term support” is vital. This can include providing healthy sexuality education and confidential support groups where the students can learn about trafficking and recruiting methods. Additionally, it is a place where an at-risk student can quickly be transitioned to intensive case management if necessary.
3. The importance of patience in working with this population over a long period of time. It can take some girls as long as two years to be able to recognize or admit that they have been trafficked.
4. Lastly, those who work with this population need to practice intensive self-care. This can include exercise, healthy eating, participating in nature, weekly staff meetings to discuss challenges, and staff trainings on self-care and stress management.¹⁶

Native American youth are at a greater risk for homelessness.¹⁷ They have disproportionate representation in homeless shelter and transitional living programs.¹⁸ There has been difficulty in getting an accurate assessment of how many Native American Alaska Native youth are homeless due to issues such as inadequate rural outreach, government mistrust, and varying definitions of homelessness in tribal communities. Additionally, homeless Native American youth may not fit the federal definition of homeless, which can further prohibit them from accessing human services.¹⁹

Host Home Programs are an innovative way to provide housing for homeless AI/AN youth. The Family and Youth Services Bureau (FYSB) has been supporting grantees that utilize the host home model to support runaway youth and homeless youth programs. This model has been particularly helpful for those in rural areas because it is a more practical option than typical short-term shelters and long-term transitional housing.²⁰ FYSB provides an overview of how to get started in creating a Host Home Program for Native youth.