Puberty and Adolescent Life Stages as an Integral Piece of Resilience in Native Americans: A Life Course Approach Aurora Trujillo, Taos Pueblo MPH Student – Public Health Policy and Management Concentration University of Arizona - Mel & Enid Zuckerman College of Public Health

Fostering resilience in the adolescent stage is key to promoting positive health outcomes in adulthood. As suicide rates and substance abuse rates among this age group remain high, a literature review is elemental for exploring the protective factors affecting resilience in overcoming risks.

Objective Identify protective factors affecting resilience Understand how resilient outcomes are being defined in the literature for the AI adolescent population Gather information to be leveraged by the public health and medical field to improve health in this population While these processes and characteristics are useful in identifying resilient youth/adolescents, understanding how these processes and characteristics are generated and developed remains vital to program and intervention planning in the public health and medical community.

Resilience in the adolescent population Resilience is the attainment of wellbeing or a positive outcome, according to the life stage developmental abilities and successful attainment despite risk factors. (Burack, Blinder, Flores, & Fitch, 2007) There are some issues in defining what resilience means to the special population of American Indian adolescents. A popular resilient outcome for this population is academic achievement, given its tangible connection to employment opportunities in adulthood. (Burack, Blinder, Flores, & Fitch, 2007) UNGER defines resilience is the process that is helpful to individuals (as well as families and communities) in achieving desired behaviors and overcoming adversity (Ungar 2012). For the series of paper, we tend to come back to the Ungar definition, but I like this one because of it’s relation to specific developmental stages.

Methods Parameters for inclusion: Peer-reviewed and available on PubMed Published from 1990-2013 in English Native American target population Identify adolescence from puberty to young adulthood (11-21 years of age) Contain concepts such as protective factors, cultural identity, self-esteem, self-concept, and social environment I went to PubMed, because as a public health student, I find this as a common starting place for information on health. I realize that I may have been able to expand my search to other databases, but this is the best for health focus. To be included in the review, the article had to be (1) available on-line on PubMed and peer-reviewed; (2) available in full-text; (3) published between 1990 and 2013 (This is because of the development of technology during this time. Also people who were born in this range are currently in the adolescent youth stage); and (5) focus on resilience in Native American adolescents. The age range for the review is large because I wanted to be inclusive in this review, the articles defined adolescence differently. All study designs were included. Articles that discussed clinical encounters only were excluded because the clinical environment does not provide insight to naturally occurring sources of resilience.

Search Terms Terms entered into PubMed Central search database Population Factors Age Group Other terms Native American Self-Concept Adolescent Resilience American Indian Protective Factors Youth Success American Native Continental Ancestry Group Cultural Identity Puberty Aboriginal Social Health These are search terms and not search combinations. Terms entered into PubMed Central search database

Results

Publications Cummins, J.-R. C., Ireland, M., Resnick, M. D., & Blum, R. W. (1999). Correlates of Physical and Emotional Health Among Native American Adolescents. Journal of Adolescent Health (1999) 4, 38-44. Lowe, J. (2006). Teen Intervention Project - Cherokee. Pediatric Nursing (32) 5, 495-500. Lowe, J., Riggs, C., Henson, J., & Liehr, P. (2009). Cherokee Self-Reliance and Word-Use in Stories of Stress. Journal of Cultural Diversity (16) 1, 5-9. Pu, J., Chewning, B., St. Clair, I. D., Kokotailo, P. K., Lacourt, J., Wilson, D. (2013). Protective Factors in American Indian Communities and Adolescent Violence. Maternal Child Health Journal (2013) 17, 1199-1207. Whitesell, N. R., Mitchell, C. M., Kaufman, C. E., & Spicer, P., the Voices of Indian Teen Project Team (2006). Developmental Trajectories of Personal and Collective Self-Concept Among American Indian Adolescents. Child Development (77) 5, 1487-1503. Whitesell, N. R., Mitchell, C. M., & Spicer, P., the Voices of Indian Teens Project Team (2009). A longitudinal study of self-esteem, cultural identity, and academic success among American Indian adolsecents. Cultural Diversity Ethnic Minority Psychology(15) 1, 38-50.

What does resilience in adolescence look like? Resilient-related outcomes of interest: Emotional Health Decreased perceived stress Decreased substance use Decreased in violent behavior Healthy personal and collective self-concept Academic success

Primary factors contributing to positive outcome of interest Perceived family caring or connectedness Self-reliance (developed in individuals by being supported, being instructed, and being sponsored) Identification of family” in personal expression Parental monitoring and self-efficacy Positive self-concept and high self-esteem Personal resources

Secondary factors contributing to positive outcome of interest Self-esteem (body pride) Displayed behaviors of responsibility, discipline, and confidence Growth in social support Perceived competencies Internal locus of control Problem-focused coping skills If we are just looking at resulting keywords, self-concept interestingly comes up as both a factor and an outcome.

Summary The articles discussed differing levels of sources of resilience: Personal level sources – American Indian personal cultural identity, self-efficacy, self-esteem Environmental level sources – family and social support Family and general social support, were found to be the most influential factors in promoting resilience in NA adolescents in this literature review. There were also observed differences between gender and culture groups in some articles.

Discussion When designing programs and interventions aimed at increasing resilience in NA adolescents, approach must be tailored to specific culture and consider gender differences. Limitations in the literature: No account of community resilience in the youth population No focus of special populations Deficit-based Articles focused interventions programs

Recommendations Next directions for exploration… Community resilience specific to youth Enhanced by use of study designs and/or mixed methods Explore the NA adolescent sub-group: Pregnant and parenting teens Rural and off-reservation populations Experience of teens living in foster care or are adopted If I may toss in a couple of anecdotes here….. I worked on the Blackfeet Reservation for the Teen Pregnancy and Parenting Coalition collecting qualitative data on their experiences, and they will have their own specific outcomes of resilience. They live in an extremely rural area. I also did a small project for a class working with youth clients of the Tucson Indian Center, these youth are going to have different protective factors.

Thank You This work was supported by the Center for American Indian Resilience (CAIR), a NIH-NIMHD P20 Exploratory Center for Excellence(1p20MD006872) awarded to Northern Arizona University with subcontracts to University of Arizona and Dine College.