Stressors and Health Inequities within American Indian Tribal Communities

Introduction: AIANs experience health disparities at an alarming rate. A contributing factor may be differential and unique experiences related to socio-environmental stressors. To address inequities and further explore the role that stressors play in the onset and severity of negative health conditions among AIANs, this mixed methods study classified stressors, partially tested the Indigenist Stress Coping Model, and determined the prevalence of adverse childhood experiences within 5 reservation-based tribal communities.

Methods: First, a secondary data analysis of 5 focus groups representing 5 tribal communities was conducted using a directed content analysis method. Participants were adult AIs with a diagnosis of Type 2 diabetes who were asked to discuss their stress experiences. Multiple rounds of qualitative coding and analysis were conducted using an iterative process to capture and categorize the characteristics and dimensions of stressors. Second, quantitative data was analyzed to determine the prevalence of child maltreatment and household dysfunction within these same communities.

Results: A broad range of stressors were identified and findings support the Indigenist Stress Coping Model. Stressors were examined along multiple dimensions and placed into a multilevel categorical matrix. Three broad stressor dimensions were identified: discrete, ongoing, and other mixed (e.g. historical trauma as etiology and reverberation). Most stressors were identified as being related to: family/community conflict; management or anticipatory anxiety related to disease; discrimination; poverty; and other social environment stressors. Stressors were also coded as life change events, chronic role strains, non-events, daily hassles, traumatic events and historically traumatic events. Social context was also noted (e.g. individual, family, community). Rates of child maltreatment and household dysfunction were determined via a retrospective adverse childhood experience survey.

Conclusions: This work lays the foundation to most appropriately and effectively study stress exposure among AI/ANs while highlighting the complex nature of stressors. The multilevel model will allow researchers to accurately develop operational definitions of independent variables; inform precise stress measurement instruments that take into account the particularities identified; and contribute to practice, intervention development, and policy as subtypes of stressors can be targeted.