Source: History of American Women , 2 Apr. 2017,

1. Prevalence of Substance Abuse Amongst Native Americans in Massachusetts in Comparison to the General Population Priyanka Bhakhri, Stacey Wainaina, Isabella Izidoro Source: History of American Women, 2 Apr. 2017,

2. What is Substance Abuse? • Substance abuse refers to patterns of substance use which can lead to impairment in functioning (DSM-IV) • Substance dependence is continued drug use despite related problems such as increase in tolerance and withdrawal symptoms • Includes illicit drugs (National Household Survey on Drug Abuse (NHSDA) • Marijuana, hallucinogens, cocaine (crack), inhalants, heroin and prescription drugs used non-medically -

3. What is a Health Disparity? “The differences in incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States” (NIH). Bennett, Kelsey. “Important NIH Updates.” Medicine Matters, 23 Oct. 2018, medicine-matters.blogs.hopkinsmedicine.org/2018/10/important-nih-updates/. 3 “Ask the Expert: NIH Grants.” Rock Health, rockhealth.com/ask-the-expert-nih-grants/.

4. Prevalence of Substance Abuse: Native Americans vs. General Population in Massachusetts • Prevalence: number of cases present at a given time in the population • The number of Native Americans that were abusing substances such as alcohol, cigarettes, and marijuana in most recent data was significant in comparison to the general population. Source: Massachusetts Department of Public Health. Massachusetts Behavioral Risk Factor Surveillance System

5. History of Native American Substance Abuse • Predisposed to alcoholism due to cultural decimation and interactions with non-Indians • Creation of federally funded boarding schools targeted Native American youth • Drinking begins among youth in boarding schools • Cultural Assimilation strips youth of their traditions

6. Evidence of the Disparity The effects of social determinants

7. What are Social Determinants of Health? Source: “Social Determinants of Health.” Social Determinants of Health | Healthy People 2020. www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.

8. Youth Risky Behavior: Native Americans vs. General Population Source: Massachusetts Department of Education

9. Education: Native Americans vs. General Population Source: U.S. Census Bureau, Census 2000 Summary

10. Income and Poverty: Native Americans vs. General Population Source: U.S. Census Bureau, Census 2000 Summary Tape File 3 (STF3). Source: U.S. Census Bureau, Census 2000 Summary Tape File 3 (STF3).

11. Health Status and Health Insurance Access: Native Americans vs. General Population Source: Massachusetts Department of Public Health, Bureau of Substance Abuse Services.

12. Quality of Life in Massachusetts: Native Americans vs. General Population Source:2019 County Health Rankings Report

13. Conclusion What does the future hold?

14. Summary of Evidence • Prevalence of substance abuse in the Native American population in Massachusetts is fortified by: • Youths engaging in risky drug abuse behavior • Low high school and college graduation rate • Low income per household • High percentage of persons and families living in poverty • Low access to health professionals • Diminished quality of life

15. Looking Towards the Future • Preventative methods • Reconnect with the culture • Creating programs centered around community values • Focusing on age specific interventions • Creating a better healthcare infrastructure (access to rehabilitation programs) • Opening up the conversation to consider social determinant factors

16. Questions? 3 Questions You Need To Ask Before Buying A Home.” Keeping Current Matters

17. Works Cited Bailey, Zinzi. “Structural Racism and Health Inequities in the USA: Evidence and Interventions.” The Lancet, Elsevier, 6 Apr. 2017, www.sciencedirect.com/science/article/pii/S014067361730569X. Brown-Rice, Kathleen. “Examining the Theory of Historical Trauma Among Native Americans.” The Professional Counselor, vol. 3, no. 3, 2013, pp. 117–130., doi:10.15241/kbr.3.3.117. Charmaine Degann. “Native Americans and Massachusetts Bay Colony.” History of American Women, 2 Apr. 2017, www.womenhistoryblog.com/2007/10/native-americans-and-massachusetts-bay.html. Cunningham, James K, et al. “Alcohol Use among Native Americans Compared to Whites: Examining the Veracity of the ‘Native American Elevated Alcohol Consumption’ Belief.” ScienceDirect, ELSEVIER, 1 Mar. 2016, www-sciencedirect-com.silk.library.umass.edu/ science/article/pii/ S037687161501830X. Enoch, Mary-Anne. “The Role of Early Life Stress as a Predictor for Alcohol and Drug Dependence.” SpringerLink, Springer-Verlag, 2 July 2010 , link.springer.com /article/10.1007/s00213 -010- 1916-6. Evans-Campbell, Teresa, et al. “Indian Boarding School Experience, Substance Use, and Mental Health among Urban Two-Spirit American Indian/Alaska Natives.” The American Journal of Drug and Alcohol Abuse, vol. 38, no. 5, 29 Aug. 2012, pp. 421–427., doi:10.3109/00952990.2012.701358. “The Health Status of American Indians/Native Americans in Massachusetts.” Mass.gov, 2006, www.mass.gov/orgs/office-of-data-management-and-outcomes-assessment. Gracey, Micheal. “Indigenous Health Part 1: Determinants and Disease Patterns.” The Lancet, Elsevier, 2 July 2009, www.sciencedirect.com/science/article/pii/S0140673609609144. Kcm. “3 Questions You Need To Ask Before Buying A Home.” Keeping Current Matters, KCM Crew Https://Www.keepingcurrentmatters.com/Wp-Content/Uploads/2017/01/KCMBannerNoWebsiteDarkLarge.png, 1 Apr. 2019, www.keepingcurrentmatters.com/2019/04/15/3-questions-you-need-to-ask-before-buying-a-home/. King, Malcolm. “Indigenous Health Part 2: the Underlying Causes of the Health Gap.” The Lancet, Elsevier, 2 July 2009, www.sciencedirect.com/science/article/pii/S0140673609608278. Li-Tzy Wu, et al. “Racial/Ethnic Variations in Substance-Related Disorders among Adolescents in the United States.” Archives of General Psychiatry, no. 11, 2011, p. 1176. EBSCOhost. Pamies, Rubens J. M. D. Multicultural Medicine and Health Disparities: Essentials for Clinical Practice. McGraw-Hill, 2006. Straussner, Shulamith Lala Ashenberg. Ethnocultural Factors in Substance Abuse Treatment. Guilford Press, 2001. EBSCOhost. “Social Determinants of Health.” Social Determinants of Health | Healthy People 2020, www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Sotero, Michelle M. A Conceptual Model of Historical Trauma: Implications for Public Health Practice and Research. Journal of Health Disparities Research and Practice, 2006, www.ressources-actuarielles.net/ext/isfa/1226.nsf/9c8e3fd4d8874d60c1257052003eced6/bbd469e12b2d9eb2c12576000032b289/$FILE/Sotero_2006.pdf. Whitbeck, Les B., et al. “Substance Abuse Prevention in American Indian and Alaska Native Communities.” The American Journal of Drug and Alcohol Abuse, vol. 38, no. 5, Sept. 2012, pp. 428–435. EBSCOhost, doi:10.3109/00952990.2012.695416. “Medicaid & CHIP for American Indians and Alaska Natives.” HealthCare.gov, www.healthcare.gov/american-indians-alaska-natives/medicaid-chip/.