A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / American Indians and American Native (AI/AN) populations have faced health disparities for a period of time. Although their incidence for some chronic diseases such as cancer, may be lower than the general population, they suffer from the poorest survival rates of any ethnic group. As the AI/AN populations age and live longer with chronic disease as seen with the rest of the general population, the discussion of palliative care is becoming more important. Currently, there is not a lot of literature about palliative care that is specific to the AI/AN population. The paucity of research serves as an impetus to learn and examine the need of available palliative care resources for the AI/AN populations. We present the analysis of twenty interviews with staff members of local hospice organizations and hospitals. The interview questions ask participants about their views and experiences in delivering palliative care. Through these discussions, we investigate the current needs, social and cultural barriers, and the infrastructure of how palliative care is accessed and delivered.

The purpose of this study was to explore the postsecondary education transition experiences of graduates of Choctaw Central High School (CCHS) who received support from the Tribal Scholarship Program (TSP) to better understand the barriers to successful postsecondary completion and the means to overcoming those barriers. Successful transitions are key for students to persist to academic completion. Studies show that American Indian students have low rates of college completion and experience a variety of factors attributed to withdrawal from college. This study provided insight into college success experienced by American Indian students and an understanding of the opportunities for a college education their scholarship program provides. Suggestions for improving the preparation of students and operation of the scholarship program are offered. The participants in this study were CCHS graduates who received support from the TSP for postsecondary education. A case study with a survey component research design was used in this study. Data from a cross-sectional survey, interviews, and observations were collected. A total of 87 past and present TSP supported students participated as survey respondents. Purposeful sampling in the form of maximum variation was used to select 6 respondents for researcher conducted interviews. The findings of this study documented four themes that characterized the transition experience of respondents to postsecondary education. Additionally, within these themes three general barriers to successful postsecondary completion were revealed. The general barriers included: (a) racial conflict with peers or faculty, (b) being overwhelmed academically, and (c) having to care for a legal dependent. The themes and barriers are discussed in the context of three primary factors related to postsecondary completion for American Indian students: sociocultural, academic, and personal factors. Recommendations included: (a) assessing and addressing the unique needs of nontraditional students in the Tribal Scholarship program, (b) arranging for an after hour study and tutoring facility for Tribal Scholarship Program students who commute from the reservation to college, (c) beginning orientation to the Tribal Scholarship Program with 9th graders, (d) providing on-campus mentoring opportunities for Tribal Scholarship Program participants, and (e) expanding this research to public school graduates who participate in the Tribal Scholarship Program.

Background: Suicide rates among Alaska Natives in rural Alaska are almost 16 times higher than the national average. Some studies in northern latitudes have shown seasonal variation among suicide rates, with differences in patterns by age and sex, reasons for this variation and contributing factors are unclear. We modeled our hypotheses based on the assumption that vitamin D deficiency influences seasonal variation of suicide. We assessed the relationship between age, sex and seasonal variation of suicidal behavior in a rural region of Alaska. Methods: We utilized data from 804 individuals who exhibited lethal and nonlethal suicidal behavior (1990-2009). Information on age, sex, and potential contributing factors were recorded via a case report. We used multivariable logistic regression to identify the association between age, sex, and seasonality of suicide. Results: Among women, we observed a significant 41% increase in odds during season two compared to season one (OR=1.41, CI=1.06, 1.90); women had a significant 48% increase in odds during season two using data collected between 2002-2009 (OR=1.48, CI=1.04, 2.11). We did not observe any significant findings of seasonality with respects to age. The observed seasonal variation of suicide did not support vitamin D deficiency as an underlying cause, as increased incidence of suicide continued into the summer months when vitamin D deficiency would be less prevalent. Conclusion: We observed evidence of seasonal variation of suicidal acts by sex. Future studies of physiologic mechanisms influencing seasonality of suicide are important to target those at highest risk throughout the year.

Indigenous populations in the U.S. have been suffering from a youth suicide epidemic for decades. The epidemic and risk factors associated with it can be connected to the mistreatment of Native Americans throughout history which has caused their communities to suffer from numerous inequalities such as poverty, inadequate housing, loss of land, and destruction of culture. Using the concepts of biopolitics, post-colonialism, and structural violence, I argue that the social and political institutions forced upon Native American communities have led to increased alcohol and drug abuse, poverty, and disempowerment, all important factors that aid in the youth suicide epidemic. I also suggests that preventative programs not only focus on suicide but other risk factors involved such as alcohol and drug abuse.

The purpose of this study was to gain a better understanding of the current practice of and barriers specific to recruiting Native American foster homes in urban areas. The literature review suggested that historical, cultural, and bureaucratic barriers to recruitment existed. The study used a qualitative, exploratory design. The data was obtained from in-depth interviews with 10 individuals whose job it is or has been to recruit Native American foster homes. The participants were employed with either a foster family agency, county child welfare agency, or a supporting organization servicing Los Angeles County and/or the San Francisco Bay Area. The interviews were conducted using a semi- structured interview guide designed by the researchers. The findings suggest that the recruitment of Native American foster families is hampered by: expense/lack of financial support, Resource Family Approval, understated deficiency and need, Native American recruitment not prioritized, bias and judgement, vulnerability and the value of privacy, distrust of government, lack of cultural awareness, absence of connection to the community, and tribal enrollment of caregiver. The research also identified proactive efforts by individuals and agencies to specifically recruit Native American foster homes. The results from this study have implications for social work practice related to the recruitment and retention of Native American foster homes.