Cultural trauma as a fundamental cause of health disparities

Subica, Andrew M.; Link, Bruce G.

doi:10.1016/j.socscimed.2021.114574

Cited by 49 publications

(63 citation statements)

References 115 publications

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“… 1 , 2 Originating from diverse nations and US territories in Polynesia, Micronesia, and Melanesia, NH/PI people are the third-fastest growing racial group in the United States, increasing in population by >60% from 2000 to 2019. 3 Despite the rapid growth of this population and its exposure to numerous cultural traumas at the hands of the United States, 4 - 6 reliable and targeted US public health data on NH/PI people have been largely unavailable during the COVID-19 pandemic. This lack of data has arguably hindered public health’s efforts to understand and address COVID-19’s potential negative impact on NH/PI communities while limiting the ability to prevent similar public health crises from disproportionately affecting NH/PI communities in the future.…”

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confidence: 99%

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

Subica

Aitaoto²,

et al. 2022

Public Health Rep

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Objectives: Minimal research has assessed COVID-19’s unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population—an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. Methods: NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ 2 tests, independent and paired t tests, and linear and logistic regression analyses. Results: During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19–related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). Conclusions: Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.

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confidence: 99%

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

Subica

Aitaoto²,

et al. 2022

Public Health Rep

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“…Cultural modes are fundamental to health and wellbeing as they are related to self-esteem and cultural identity. They offer protection against stress and anxiety and provide the context for how people navigate social and health needs (Subica and Uchida 2022). This protection may be disrupted when cultural trauma (such as loss of land or language or any trauma affecting cultural identity) is experienced, impacting a person's (or community's) health and wellbeing (Subica and Uchida 2022).…”

Section: Characteristics Of Approaches and The Cultural Continuummentioning

confidence: 99%

Indigenous approaches to perinatal mental health: a systematic review with critical interpretive synthesis

Meredith

McKerchar

Lacey

2023

Arch Womens Ment Health

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Indigenous mothers and birthing parents experience significant inequities during the perinatal period, with mental health distress causing adverse outcomes for mothers/birthing parents and their infants. Limited literature is available to inform our understanding of solutions to these issues, with research primarily focusing on inequities. Our aim was to conduct a systematic review of Indigenous approaches to treatment of perinatal mental health illness. Following the PRISMA guidelines for systematic literature reviews, an electronic search of CINAHL, Medline, PubMed, Embase, APA PsycInfo, OVID Nursing, Scopus, Web of Science, and Google Scholar databases was conducted in January and February 2022 and repeated in June 2022. Twenty-seven studies were included in the final review. A critical interpretive synthesis informed our approach to the systematic review. The work of (Yamane and Helm J Prev 43:167–190, 2022) was drawn upon to differentiate studies and place within a cultural continuum framework. Across the 27 studies, the majority of participants were healthcare workers and other staff. Mothers, birthing parents, and their families were represented in small numbers. Outcomes of interest included a reduction in symptoms, a reduction in high-risk behaviours, and parental engagement/attachment of mothers/birthing parents with their babies. Interventions infrequently reported significant reductions in mental health symptoms, and many included studies focused on qualitative assessments of intervention acceptability or utility. Many studies focused on describing approaches to perinatal mental health distress or considered the perspectives and priorities of families and healthcare workers. More research and evaluation of Indigenous interventions for perinatal mental health illness is required. Future research should be designed to privilege the voices, perspectives, and experiences of Indigenous mothers, birthing parents, and their families. Researchers should ensure that any future studies should arise from the priorities of the Indigenous population being studied and be Indigenous-led and designed.

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“…At the individual level, HT impact includes impairments in family system disruption including communications (47), mental health symptoms, substance abuse (46), and sexual risk behaviors (43,44). At the community level, collective responses to HT include the disruption of Native culture such as Native identity, languages, traditional practices, and spirituality (44,48).…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Magarati

Chambers

Yenokyan

et al. 2022

Front. Public Health

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ObjectiveThe American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.MethodsWe analyzed baseline self-report data from 254 Native adults ages 18–55 years with recent binge substance use who were enrolled in an evaluation of “EMPWR,” a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.ResultsA little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).ConclusionOur findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

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Cultural trauma as a fundamental cause of health disparities

Cited by 49 publications

References 115 publications

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021

Indigenous approaches to perinatal mental health: a systematic review with critical interpretive synthesis

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

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