1. American Indian Veteran Healthcare

2. To describe the relationship between American Indian enculturation, demographic variables, and how these factors correlate with the utilization of VA healthcare services by American Indian veterans living in southwest Arizona.

3. Background & Significance American Indians (AI) are overrepresented as veterans (20-30%) AI veterans within mainstream population in the U.S. (10%) AI veterans under utilize VA healthcare services AI veterans 4 times more likely to report unmet health needs / PTSD Historic barriers to AI health care access - racism / discrimination - geographic isolation - cultural differences / beliefs / worldview - unemployment / social challenges

4. Theoretical Framework Historical Trauma Theory Historical Trauma Theory – Maria Yellow Horse Brave Heart, PhD (Lakota) Cumulative wounding over the lifespan and across generations resulting in HISTORICAL TRAUMA RESPONSE - historical unresolved grief due to loss of ceremony and culture - historical trauma associated symptoms depression, anxiety, substance abuse, stacked grief, violence, abuse, suicide, homicide compounded effect

5. Design & Sample Cross-sectional correlation design Convenience sample of 85 (100) veterans who are enrolled in the Southern Arizona VA Healthcare System (Tucson, AZ) Arizona has 21 federally recognized tribes 250,000 American Indians of one race – Census 2000 3 reservations Tohono O’odham 2 nd largest reservation in U.S. San Carlos Apache Reservation Fort Yuma-Quechan Reservation Tucson urban population Inclusion – “AI” enrolled in VA healthcare at SAVAHCS Exclusion – Axis I psychosis or MD w/suicidality

6. Variables & Measures American Indian Enculturation Scale Age War time era Residence (reservation / urban) # Medical Diagnoses # Psychiatric Diagnoses PTSD Marriage Religion UTILIZATION (# encounters in 5 years)

7. Data Collection Method Completion of the American Indian Enculturation Scale (.91) Enlist the support and remunerate American Indian students from the Tohono O’odham Community College and local American Indian students from the University of Arizona to work as Research Assistants (10 students) Chart Review Collaborate with SAVAHCS to make local connections Ethnographic method – interrater reliability (CHALLENGE IS ENGAGING AMERICAN INDIAN RESEARCH ASSISTANTS)

8. Analysis Multiple regression analysis

9. Conclusion Gaining insight into factors associated with utilization may provide direction for strategies to engage, treat, and retain American Indian veterans in VA healthcare. This is consistent with the mission of the VA as the principal health advocate for veterans and their families. (CHALLENGE IS ENGAGING AMERICAN INDIAN RESEARCH ASSISTANTS)