James Allen

Objective: Our goal was to better understand the impact of COVID‐19 on Indigenous family coping. The focal research question was the following: What protective factors do Indigenous women cite as buffering stressors related to COVID‐19 for themselves and their families? Background: During the COVID‐19 pandemic, Indigenous peoples experienced the highest rates of infection and mortality of any racial group; however, consistent with the framework of historical oppression, resilience, and transcendence, Indigenous peoples offset risk through positive coping and adaptation interwoven between individual, family, and community ecological levels. Methods: Thirty‐one community‐based, critical ethnographic interviews were conducted following an Indigenous toolkit for ethical and culturally sensitive research. Results: Identified themes included (a) responsibilities facilitating community care, (b) unity fostered family and cultural traditions, and (c) living in right relationship. The theme living in right relationship had four subthemes: (a) spirit, (b) self‐growth and sustaining, (c) setting priorities and sharpening parenting, and (d) sustaining connective communication. Conclusion: Indigenous families utilized traditional coping factors to address challenges amid the COVID‐19 crisis, despite continued systemic oppression. Implications: Indigenous traditional knowledge offers a vital model for healthy coping, and future interventions should promote self‐determination and sustainable, culturally relevant coping practices for Indigenous communities during crises like the COVID‐19 pandemic.

This paper describes Alaska Native youth-identified community strengths that support young people’s well-being. Youth from three rural Alaska communities were engaged by the research team in digital storytelling and photovoice to explore their perspectives on what their communities were already undertaking to support youth. Each youth participant was then invited to complete an interview, which was then transcribed, coded, and qualitatively analyzed by the research team leads. The community strengths described by young people align with several community-level protective factors identified in a parent study as associated with reduced risk of youth suicide. Findings illustrate that protective communities help young people build and maintain supportive relationships with community members, family, and peers, and promote their connection to their culture, including by providing opportunities to learn their language, history, and culture; to be out on the land hunting and fishing; and to practice traditional ceremonies and spirituality. Communities implementing initiatives that support these factors may protect young people from youth suicide.

Suicide research has focused primarily on risk factors at the individual level, overlooking the potential for community-level factors that confer protection from suicide. This study builds on the concept of cultural continuity from the Indigenous suicide prevention literature. It seeks to understand the collective influences shaping individual experiences across time and frames resilience as a culturally situated process that helps individuals to navigate challenges and facilitate positive health behaviors. A collaborative Alaska Native (AN) partnership designed the Protective Community Scale (PCS) to identify mutable community-level protective factors in rural AN communities hypothesized to reduce suicide among youth, who represent the highest risk demographic in this at-risk population. Study objectives were to (a) test the measurement structure of community-level protection from suicide, (b) select best functioning items to define this structure, and (c) test the association of community protection with community-level suicide deaths and attempts. In 65 rural AN communities, 3–5 residents (n = 251) were peer-nominated for their knowledge of local resources and completed the PCS in structured interviews. Findings show community members can reliably assess the theoretically rich, multidimensional community-level protective factor structure of cultural continuity with sufficient precision to establish its inverse association with community-level suicide. Community-level protection emerges as a promising approach for universal suicide prevention in Indigenous contexts that can guide multi-level strategies that expand beyond individual-level, tertiary prevention to focus on the continuity of cultural processes as resources to build protection. These findings point the field toward consideration of cultural continuity and community protection as key factors for Indigenous suicide prevention.

Chandler and Lalonde broadened the scope of inquiry in suicide research by providing theoretical grounding and empirical support for the role of community, culture, and history in understanding Indigenous youth suicide and reimagining its prevention. Their work pushed the field to consider the intersectional process of individual and collective meaning-making in prevention of Indigenous suicide, together with the central role culture plays in bringing coherence to this process over time. Their innovation shifted the research focus to include the shared histories, contexts, and structures of meaning that shape individual lives and behaviors. We describe here a new generation of research extending their pathbreaking line of inquiry. Recent work aims to identify complex associations between community-level structures and suicidal behavior by collaborating with Alaska Native people from rural communities to describe how community protective factors function as preventative resources in their daily lives. Community engagement and knowledge co-production created a measure of community protection from suicide. Structured interviews with rural Alaska Native community members allowed use of this measure to produce relevant, accessible, and actionable knowledge. Ongoing investigations next seek to describe their mechanisms in shaping young people's lives through a multilevel, mixed-methods community-based study linking community-level protection to protection and well-being of individual youth. These efforts to understand the multiple culture-specific and culturally mediated pathways by which communities build on their strengths, resources, and practices to support Indigenous young people's development and reduce suicide risk are inspired by and expand on Chandler and Lalonde's remarkable legacy.

The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.

Youth suicide is increasing in the United States, with deaths among younger people of color driving this upward trend. For more than four decades, American Indian and Alaska Native (AIAN) communities have suffered disproportionate rates of youth suicide and years of productive life lost compared to other U.S. Races. The National Institute of Mental Health (NIMH) recently funded three regional Collaborative Hubs to carry out suicide prevention research, practice, and policy development with AIAN communities in Alaska and rural and urban areas of the Southwestern United States. The Hub partnerships are supporting a diverse array of tribally-driven studies, approaches, and policies with immediate value for increasing empirically driven public health strategies to address youth suicide. We discuss unique features of the cross-Hub work, including: (a) long-standing Community-Based Participatory Research processes that led to the Hubs’ innovative designs and novel approaches to suicide prevention and evaluation, (b) comprehensive ecological theoretical approaches that contextualize individual risk and protective factors in multilevel social contexts; (c) unique task-shifting and systems of care approaches to increase reach and impact on youth suicide in low-resource settings; and (d) prioritization of strengths-based approaches. The work of the Collaborative Hubs for AIAN youth suicide prevention is generating specific and substantive implications for practice, policy, and research presented in this article at a time when youth suicide prevention is a dire national priority. Approaches also have relevance for historically marginalized communities worldwide.

The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.

In community interventions more generally, the concept of fidelity refers to the degree to which a program is delivered as intended. The present paper discusses ways in which fundamental aspects of participatory research challenge the concept of fidelity and differ from more traditional science-dominated approaches. We begin with a discussion of the fidelity concept and some of its strengths and limitations. We then discuss both social problems and proposed solutions as representing complex problems defying simple or permanent solutions. We suggest that three prominent aspects of participatory research highlight this complexity and pose challenges in assessing fidelity. First, in participatory research, the goal is not only scientific but also social action on a local issue as well. Second, the participatory process among varied partners is itself part of the intervention itself to be understood as affecting both processes and outcomes. Third, the goals of participatory research include community-level as well as individual-level changes. These issues are illustrated in a discussion of how culture is conceptualized and acknowledged in fidelity assessment. We conclude with some recommendations for approaching fidelty in participatory research in a way that appreciates its differences from more traditional paradigms underlying community interventions.

Suicide is the second leading cause of death among American Indian and Alaska Native youth, and within the Alaska Native youth subpopulation, the leading cause of death. In response to this public health crisis, American Indian and Alaska Native communities have created strategies to protect their young people by building resilience using localized Indigenous well-being frameworks and cultural strengths. These approaches to suicide prevention emphasize promotion of protective factors over risk reduction. A measure of culturally based protective factors from suicide risk has potential to assess outcomes from these strengths-based, culturally grounded suicide prevention efforts, and can potentially address several substantive concerns regarding direct assessment of suicide risk. We report on the Reasons for Life (RFL) scale, a measure of protective factors from suicide, testing psychometric properties including internal structure with 302 rural Alaska Native Yup’ik youth. Confirmatory factor analyses revealed the RFL is best described through three distinct first-order factors organized under one higher second-order factor. Item response theory analyses identified 11 satisfactorily functioning items. The RFL correlates with other measures of more general protective factors. Implications of these findings are described, including generalizability to other American Indian and Alaska Native, other Indigenous, and other culturally distinct suicide disparities groups.