Background American Indians and Alaska Natives have traditionally used stories and drawings to positively influence the well-being of their communities. Objectives The objective of this study was to describe the development of a curriculum that trains Native youth leaders to plan, write, and design original comic books to enhance healthy decision making. Methods Project staff developed the Native Comic Book Project by adapting Dr. Michael Bitz’s Comic Book Project to incorporate Native comic book art, Native storytelling, and decision-making skills. After conducting five train-the-trainer sessions for Native youth, staff were invited by youth participants to implement the full curriculum as a pilot test at one tribal community site in the Pacific Northwest. Implementation was accompanied by surveys and weekly participant observations and was followed by an interactive meeting to assess youth engagement, determine project acceptability, and solicit suggestions for curriculum changes. Results Six youths aged 12 to 15 (average age = 14) participated in the Native Comic Book Project. Youth participants stated that they liked the project and gained knowledge of the harmful effects of commercial tobacco use but wanted better integration of comic book creation, decision making, and Native storytelling themes. Conclusion Previous health-related comic book projects did not recruit youth as active producers of content. This curriculum shows promise as a culturally appropriate intervention to help Native youth adopt healthy decision-making skills and healthy behaviors by creating their own comic books.

Background Nutrition therapy is essential in critically ill adults. Little is known about appropriate nutrition therapy in patients with severe coronavirus disease 2019 (COVID‐19) infection. Methods This was a retrospective, observational study in adult patients with confirmed COVID‐19 infection receiving mechanical ventilation. Data regarding patient demographics and nutrition therapy were collected. Patients that received enteral nutrition within 24 hours of starting mechanical ventilation were compared with patients starting enteral nutrition later. The primary outcome was inpatient length of stay. Propensity score matching was conducted to control for baseline differences in patient groups. Results One hundred fifty‐five patients were included in final analysis. Patients who received enteral nutrition within 24 hours received a significantly greater daily amount of calories (17.5 vs 15.2 kcal/kg, P = .015) and protein (1.04 vs 0.85 g/kg, P = .003). There was no difference in length of stay (18.5 vs 23.5 days, P = .37). The propensity score analysis included 100 patients. Following propensity scoring, significant differences in daily calorie (17.7 [4.6] vs 15.1 [5.1] kcal/kg/d, P = .009) and protein (1.03 [0.35] vs 0.86 [0.38] g/kg/d, P = .014) provision remained. No differences in length of stay or other outcomes were noted in the propensity score analysis. Conclusion Initiation of enteral nutrition within 24 hours was not associated with improved outcomes in mechanically ventilated adults with COVID‐19. No harm was detected either. Future research should seek to clarify optimal timing of enteral nutrition initiation in patients with COVID‐19 who require mechanical ventilation.

This paper builds a Critical Race Theory approach to consider how mixed-race American Indian college students conform to, or resist, dominant black/non-black ideology.Current research on multiracials in the U.S. lacks the perspectives of mixed-race American Indians on the heightened disputes of “Indianness,” tribal enrollment, and tribal self-determination. Also under-explored is how mixed-race American Indian persons perceive themselves in racial terms, how they wish to be perceived, and how economic and historical perspectives inform their choices about racial self-identification.This paper provides an overview of the identity politics of mixed-race American Indians at a tribal college and highlights the need for tribal colleges to embrace a growing mixed-race population through self-determination education policies.