American Indian and Alaska Native Early Childhood Health: A Systematic Review

Nicolette Teufel - Shone, PhDCollege of Public Health, University of Arizona

2014 Native Research Network Conference, Phoenix, AZ

Conceptual framework

Using the Life Course Approach, this review examines the social and political determinants that shape AIAN early childhood health

For all populations, childhood development and health has both lifelong and intergenerational effects (Shonkoff et al. 2012)

Identifying contextual factors that impact resilience and stress early in life is essential to guide public health action for a healthier population

Objective of this reviewUnderstand the state of the science which

serves as the foundation for public health action to health equity

Identify how social determinants of health and the socio-ecological model are used in understanding and improving the health of young AIAN children

Understand context

MethodsStandard procedures of the Cochrane Collaboration

(2008) for systematic review of primary research in health care and policy

Three databases searched: PubMed, Web of Science and EBSCO which includes PsycINFO and CINAHL

Search terms: American Indian (AI) Children, AI Early

Childhood; Native American Children; Native American Early Childhood; Alaska Native (AN) Children; AN Early Childhood; AI Children and Families, Native American Children and Families; and AN Children and Families

Study Inclusion and Exclusion Criteria Available in English; peer-reviewed

Available electronically. published by April 1, 2014

Target population was predominantly AI and/or AN children, < 12 yrs

Described a nonclinical encounter that addressed the context of health outcomes and/or an intervention designed for AI/AN children

Applied socio-ecological or social determinants of health framework

Limited to AI/AN children of US tribes who entered into treaty agreements and endured a unique set of stressors linked to the residential, educational and governance requirements of the US government (Gone & Trimble, 2012)

Native Hawaiians not included, not covered by Indian Health Service, an agency having a distinct, homogenizing impact on the services provided to young AI/AN children

Number of different articles identified in database search (n=287)

Titles and abstracts excluded, focus not early

childhood (n=195)

Articles reviewed by primary categories (n=77)

Excluded, socio-ecological framework

not applied ( n= 70)

Articles included (n=7), all address family dynamics and

influence

Over-nutrition in AIAN early

childhood (n=37)

Dental health in AIAN early

childhood (n=16)

Family dynamics and

influence (n=17)

Community dynamics and

influence (n=7)

Excluded as Other ( n= 10)

Nominal Categorical Analysis of Literature: American Indian and Alaska Native Early Childhood

ResultsOf the initially identified 287 articles addressing AI/AN

early childhood health, only 7 met the criteria that included use of socio-ecological framework, addressing context

All 7 addressed family dynamics or family oriented services influence on childhood health

Four addressed socio-cultural resources and stressors in AI families that influence childhood physical, mental and emotional health

Three 3 addressed family behaviors grounded in AI/AN values, worldviews and experiences that shape early childhood physical, mental and emotional wellness

Resources and stressors of AI families with young children

Cunningham-Sabo et al. (2008) Focus groups with 41 parents and staff of Navajo Head Start Program Identified need for: 1) community-level action to change

the food environment; 2) stronger parenting skills to control the food environment; and 3) culturally relevant strategies for caregivers

Bauer et al. (2012) Survey of 432 parents or caregivers of Lakota children Food insecurity associated with: 1) practice of feeding

children calorically dense foods linked to history of food scarcity and desire to have heavier children; and 2) pervasive feeling of inadequacies, stress and depression

Resources and stressors of AI families with young children

Crofoot and Harris (2012) Review of historical practices that devastated AI families and policies of Indian Child Welfare Act Child welfare systems retain elements of systematic bias

from 200 years of US policy challenging AI families. Need systems based on AI strengths, e.g.,

interdependence of extended family, respect, and role of elders in leadership, discipline and spiritual guidance

Bussey and Lucero (2013) Case study of Denver Indian Family Resource Center (DIFRC) and AI families in the Denver area DIFRC implemented a Family Preservation Model that

addresses family stressors and mental health, cultural strengths (extended family/kinship) and referral to materials resources.

System change and improvement in staff training

Family Behaviors that shape the early childhood experience Cheshire (2001) Interviews with 10 dyads, AI mothers + children

Cultural transmission - Children expected to be quiet, observe and learn

Listening is highly valued; asking questions is non-traditional transmission

Red Horse (1997) Literature review and counseling experience with AI families In traditional families, children raised in extended kin systems;

household residents are multi-generational , related by blood, marriage or adoption

Family members are always reminded of their place and responsibilities in the kinship system

Simmons et al. (2004) SAMSHA funded (Circle of Care) AIAN communities work to redefine serious emotionally disturbed (SED) children Definitions assert the role of the social and cultural environment in

shaping children’s physical, emotional, spiritual, and intellectual health SED Children with SED are from families who experienced trauma and

suffer from historical wounding. Shame and anger are acted out in addiction, suicide attempts, violent acts and other ant-social behaviors

DiscussionSeven articles quite different, commonality is focus on

context

Literature on early AI childhood health has Focused on epidemiology of health conditions, predominantly

over-nutrition and dental health Have applied a framework that guides assessments and

interventions that emphasizes responsibility of parents

Reflections of the socio-political-historical context of family resources, stressors and behaviors influencing the physical, mental and emotional health of young AI children is not prevalent in the literature

Conclusions Impact of social injustice on AIAN childhood health can not be

change in period of most external funding sources

Identification of short-term indicators of change in social determinants of health is needed and acceptable as feasible outcomes

Future public health efforts to understand and enhance AI childhood health should Examine contexts that yield healthy physical, mental and emotional

outcomes; identify factors linked to positive health outcomes

Identify, discontinue and change social-political and historical systems that reinforce family trauma by blaming families;

Need to focus on AI values that supporting raising healthy children in balance with their social and physical environment

Questions?

Contact InformationNicolette I. Teufel-Shone, PhD

teufel@email.arizona.edu

Work supported by: Center for American Indian Resilience ( CAIR) NIH – NIMHD P20 Exploratory Center of Excellence

(1P20MD006872) Awarded to Northern Arizona University Subcontracted to University of Arizona and Diné College