1. Themes Related to Social Interaction and Health Resilience Among Urban American Indians Lisa J. Hardy, R. Cruz Begay, and Elizabeth Hulen An Exploratory Center of Excellence (P20) National Institutes of Health-National Institute of Minority Health and Health Disparities Grant Number: 1P20MD006872-01

2. Background  Health risks associated with lifestyles producing weight related conditions are increasingly prevalent in the United States and in American Indian populations  Many Native people have demonstrated resiliency when faced with increased health risks Research Objectives 1.To investigate how urban American Indian adults have developed successful strategies to enhance wellness. 2.To understand structural and other kinds of supports which foster resiliency in American Indians. NAU CAIR Pilot: Health Resilience among American Indians in Arizona

3. Methods  Rapid Assessment, Response and Evaluation (RARE)  Community Based Participatory Research (CBPR)  Mixed method research design  Qualitative interviewing  Focus groups  Wellness maps  Data Analysis  Inductive approach  Coding schema collaboratively developed by community researchers and investigators NAU CAIR Pilot: Health Resilience among American Indians in Arizona

4. Results – Identified Themes  Family  Community structure  Social influences NAU CAIR Pilot: Health Resilience among American Indians in Arizona

5. Family  Supportive family relationships  Engaging in wellness practices as a family  Leading by example and looking to role models  Unsupportive family relationships  Family members as stressors  Struggles within the family NAU CAIR Pilot: Health Resilience among American Indians in Arizona

6. Community Structure  Structural facilitation of wellness  Availability of support services  City parks/urban trail system for outdoor physical activities with family and friends  Access to fresh foods in urban Flagstaff  Structural facilitation of poor health  High cost of living in urban Flagstaff  Distance  Food insecurity NAU CAIR Pilot: Health Resilience among American Indians in Arizona

7. Social Influences  Wellness and social support  Family and friends  Community  Health care providers NAU CAIR Pilot: Health Resilience among American Indians in Arizona

8. Discussion  Orientation towards positivity in overall wellness goals  Wellness strategies that remove oneself from negativity  Demonstrated ability to successfully negotiate supportive and non-supportive social structures NAU CAIR Pilot: Health Resilience among American Indians in Arizona

9. Conclusion  Our analyses will be used to develop evidence-based strategies that inform:  Improved education and support from health care providers  Policy and procedural change that support wellness and health resilience NAU CAIR Pilot: Health Resilience among American Indians in Arizona