|
| A) | increased by 25%. | ||
| B) | decreased by 200%. | ||
| C) | increased by 250%. | ||
| D) | stayed relatively stable. |
Between 1960 and 2000, the population of American Indians and Alaska Natives increased by 250%, due partly to improved birth rates, more people identifying as Native American, and better data collection from the Census Bureau. In the 2020 Census, further improvements and changes to questions regarding race and ethnicity were implemented to enable a more thorough and accurate depiction of how people self-identify, especially those who identify as multiracial [3]. As a result, the number of individuals identifying as American Indian or Alaska Native alone or in combination with another race group increased 160%, from 5.2 million people in 2010 to 9.7 million in 2020. In 2020, the American Indian and Alaska Native alone population (3.7 million) accounted for 1.1% of all people living in the United States [3]. Even with greater numbers of individuals being identified, the group is still one of the smallest and most underserved in the country. American Indians and Alaska Natives in the United States consistently rank at or near the bottom of nearly every social, health, and economic indicator [34].
| A) | Both Alaska Natives and American Indians are culturally diverse. | ||
| B) | Alaska Natives and American Indians have had similar experiences with the U.S. Government. | ||
| C) | Both American Indians and Alaska Natives were, and to some extent continue to be, subsistence economies. | ||
| D) | Alaska Natives and American Indians both experienced population devastation due to diseases introduced by Europeans. |
Alaska Natives and American Indians share some similar experiences. For example, both Alaska Natives and American Indians are culturally diverse, consisting of different tribes with different languages and customs. Both American Indians and Alaska Natives were also, and to some extent continue to be, subsistence economies, an important part of Native American identity and culture. Alaska Natives and American Indians also both experienced population devastation due to diseases introduced by Europeans [1]. However, the relationship that Alaska Natives have had with the U.S. Government differs slightly from the experiences of American Indian tribes. This relationship will be discussed later in this course.
| A) | Eyak | ||
| B) | Inupiaq | ||
| C) | Athabascan | ||
| D) | Alutiiq (Sugpiaq) |
Different Alaska Native cultures and tribes were found, and continue to be recognized, throughout the state of Alaska. According to the Alaska Federation of Natives, 11 distinct cultures can be described geographically: Eyak, Tlingit, Haida, and Tsimshian peoples in the southeast; the Inupiaq and St. Lawrence Island Yupik in the north and northwest; Yup'ik and Cup'ik Alaska Natives in southwest; the Athabascan peoples in Alaska's interior; and Alutiiq (Sugpiaq) and Unangax̂ peoples in south-central Alaska and the Aleutian Islands [54]. Today, the federal government recognizes 228 tribes in Alaska [6].
| A) | was passed by Congress in 1971. | ||
| B) | required Alaska Natives to waive their claim to Native lands. | ||
| C) | set up regional and statewide structures that would give Alaska Natives political and economic power. | ||
| D) | All of the above |
The Alaska Native Claims Settlement Act (ANCSA) was passed by Congress in 1971 in order to begin the construction and development of the Trans-Alaska Pipeline System. In exchange for waving their claim to Native lands, Alaska Natives received $962 million and more than 44 million acres of land [1,5]. ANCSA had some positive effects for the Alaska Native population. For example, much of the land that had been allotted to them was inhabitable and rich in resources. Also, the settlement created 13 regional, 4 urban, and more than 200 village Native corporations, setting up regional and statewide structures that would give Alaska Natives political and economic power. However, in the early 1970s, the state legislature was reapportioned based on population; rural, mostly Native regions of the state lost a significant amount of power on the state level [5].
| A) | True | ||
| B) | False |
The Alaska National Interest Lands Conservation Act (ANILCA) of 1980 created the majority of the national parks in Alaska. ANILCA stipulates the designation of wilderness, subsistence management, transportation in and across parklands, use of cabins, mining, archaeologic sites, scientific research studies, and more [7]. Under Title VIII of ANILCA, rural residents of Alaska have priority subsistence use of federal public lands [8]. The federal management of subsistence harvests of fish and wildlife on federal land is unique to Alaska and does not exist elsewhere in the United States [9].
| A) | Celebrating Indigenous Peoples Day | ||
| B) | Blatant hate crimes against Alaska Natives | ||
| C) | General failure to acknowledge or celebrate Alaska Native culture | ||
| D) | Systematic racism perpetuated by the state and federal government through biased policies and distribution of wealth |
Racism in Alaska today can take many forms, from blatant hate crimes against Alaska Natives to a general failure to acknowledge or celebrate Alaska Native culture to systematic racism perpetuated by the state and federal government through biased policies and distribution of wealth [5]. While there is a lack of research about the relationship between experiencing racism and physical health problems of Native Americans, racism has been shown to linked to physical harm (e.g., hypertension, heart disease) among other racial/ethnic groups, such as African Americans and Latinos [15].
| A) | Suicide rates are highest among older Alaska Native women. | ||
| B) | Suicide rates in this population have been decreasing since 2015. | ||
| C) | Nearly 75% of American Indian and Alaska Native suicide victims are younger than 44 years of age. | ||
| D) | American Indians and Alaska Natives have the lowest rates of suicide of any racial or ethnic group in the United States. |
American Indians and Alaska Natives have the highest rates of suicide of any racial or ethnic group in the United States, with suicide rates increasing nearly 20% from 2015 to 2020, compared with a less than 1% national increase among the overall U.S, population. Nearly 75% of American Indian and Alaska Native suicide victims are younger than 44 years of age. Among American Indian and Alaska Natives, men are three times more likely to commit suicide than women [19].
| A) | Less than 1% | ||
| B) | 3.5% | ||
| C) | 10% | ||
| D) | 25.5% |
While American Indians and Alaska Natives (alone or in combination) make up only 2.6% of the U.S. population, nearly 3.5% of all people experiencing homelessness identify as American Indian, Alaska Native, or Indigenous. Furthermore, between 2022 and 2023, an 18% increase in homelessness rates occurred among American Indian and Alaska Natives, the greatest increase of any racial/ethnic group [27,55]. In the State of Alaska, 36 out of every 10,000 people in the general population are homeless [27]. In the city of Anchorage alone, Alaska Natives make up nearly 50% of the homeless population [28,29]. Reported reasons for homelessness include unemployment, substance use, poor mental health, relationship/family issues, eviction, and/or experiencing a behavioral or medical emergency [29].
| A) | Stroke | ||
| B) | Cancer | ||
| C) | Suicide | ||
| D) | Heart disease |
Cancer is the leading cause of death among Alaska Natives, with more than 50% of diagnosed cancers being breast, colorectal, lung, and prostate. In addition, lung cancer, colorectal cancer, cancer of the kidney, stomach cancer, and nasopharynx cancer are all more common in Alaska Natives than in the White population [24]. While cancer rates of Alaska Native women and White women were similar in the past, since the 1980s, cancer rates for Alaska Native women have increased, even as cancer rates among White women have decreased. Some risk factors, including smoking, may contribute to cancer rates; it has been found that approximately 90% of lung cancer cases are related to smoking. Additionally, an estimated 32% of Alaska Natives are current smokers,—more than twice the rate in White Americans [24].
| A) | Almost all American Indians and Alaska Natives drink at least moderately. | ||
| B) | Opioids are the most misused substance among American Indians and Alaska Natives. | ||
| C) | Genes that increase the risk of substance misuse and related factors are more common in American Indians and Alaska Natives than in White Americans. | ||
| D) | Native men and women with alcohol use disorders and those who participated in binge drinking are more likely to suffer from another psychiatric disorder. |
There is a misconception that genes that increase risk of substance misuse and related factors (e.g., tolerance, craving) are more common in American Indians and Alaska Natives than in White Americans—this is untrue [52]. Alcohol is the most misused substance among American Indians and Alaska Natives, as well as among the general population. Many American Indians and Alaska Natives do not drink at all, but binge drinking and alcohol use disorder occur among Native populations at relatively high rates [52]. In one study exploring the connection between alcohol use disorders and comorbid psychiatric disorders, Native men and women with alcohol use disorders and those who participated in binge drinking were more likely to suffer from another psychiatric disorder [1,49].
| A) | endanger the subsistence way of life. | ||
| B) | continue to lead to the displacement of rural communities. | ||
| C) | increase exposure to infectious disease due to rising temperatures and traditional ways of storing food. | ||
| D) | All of the above |
The effects of climate change can and will increasingly be seen in the Alaska Native population, affecting both physical and mental health, as well as Native communities, homes, and the subsistence way of life [46,47]. Flooding and other natural disasters related to climate change will continue to lead to the displacement of people living in rural Alaska, many of whom are Alaska Natives. With climate change comes increased exposure to infectious disease due to rising temperatures and traditional ways of storing food. Water and food sources will also be more limited, and poor water quality is already a concern for rural Native communities. In addition, the cultural importance of the subsistence way of life will be endangered, as well as the relationship that Alaska Natives have historically had with their environment [46].
Natural disasters and environmental changes caused by climate change can also be the cause of solastalgia, the distressing sense of loss that people experience as a result of unwanted environmental changes that occur close to one's home [47]. Climate change has also been linked to anxiety, depression, and post-traumatic stress disorder following extreme weather or natural disasters (e.g., erosion, fires, flooding, storms) [47]. Permafrost (defined as occurring when the ground remains frozen at 32 degrees or colder for at least two years) is found in 80% of the State of Alaska. With the thawing of permafrost in some areas, the landscape will ultimately change, possibly causing permanent damage to roadways or creating the need of some remote villages to relocate [47].
| A) | Yoga | ||
| B) | Drumming circles | ||
| C) | Therapeutic massage | ||
| D) | Traditional plant medicine |
Alaska Native culture includes many natural healing methods dating back thousands of years. Although these practices became less common because of European settlers and missionary influence, they still exist today and they are regaining popularity. There is much diversity in the beliefs and practices of natural healing methods. However, traditional Alaska Native healing methods include, but are not limited to, therapeutic massage, prayer, cleansing by the burning of sage, drumming circles, traditional plant medicine, and talking circles [43].
| A) | True | ||
| B) | False |
The perception of the elderly population can also differ in Alaska Native culture compared with White populations. For example, Alaska Native elders are never thought to reach an age when their opinions, stories, and experiences are unimportant. They continue to be a vital part of the Native community, passing culture to the younger generations. Therefore, when elder Alaska Natives have a medical condition that may require treatment or institutionalization outside of the community, it is to the detriment of the health of the elder and to the community as a whole [43]. While disengagement theory states that it is normal for elderly people to separate and disengage from society at a certain age, it is thought that in the case of Alaska Natives, it is a "forced disengagement" and not in line with Native customs and culture. In general, families and Tribes believe the best place for Native elders to be cared for is in a family home and that care should never be so restrictive as to limit elders from participating in community activities [43].
| A) | True | ||
| B) | False |
In the State of Alaska, 6% of the population lives without basic plumbing, more than any other state. Because of permafrost, some villages lack piped water and sewage and outhouses and septic tanks do not function and, therefore, cannot be used. Looking for other ways to dispose human waste, sewage is often tracked around, disturbed by animals, spilled, spread by vehicles, or blown by the wind once dry. While this is a serious hazard to community health, another more serious problem for health is the lack of clean, running water [31].
| A) | Phase out Native traditions | ||
| B) | Christianize Alaska Natives | ||
| C) | Learn more about Native ways of life | ||
| D) | Teach trades that would make students useful servants to settlers |
Like many Native Americans, Alaska Natives have a complicated history with the formal education system. In 1784, education was first imposed upon young Alaska Natives by Russian fur trader Grigory Shelikhov, and the curriculum included Christianity, Russian, and arithmetic. This first school was followed by mission schools, first operated by the Russian Orthodox Church and later by the American Protestant and Roman Catholic Churches, whose objectives were to Christianize Alaska Natives, to phase out Native traditions, and to teach students trades that would make them useful servants to the settlers. The last of the mission schools did not close until 1916 [51].
| A) | True | ||
| B) | False |
There are several barriers to education for Alaska Natives in the State of Alaska. First, many policies and programs around education are based on models used in the "lower 48" and do not translate well to the unique situation in Alaska, including geographically remote communities [48]. Also, there can be a lack of cultural understanding between students, parents, teachers, and school staff. This can also include difficulties in communication due to language differences [48,50]. School materials, standardized tests, curriculum, and teaching styles may also not take into consideration Native culture, and research has shown that Native Americans have different learning styles from non-Natives, making classroom learning more challenging [1,50]. Finally, systemic and community issues, such as poverty, alcohol use disorder, lack of educational role models, and lack of parental support, can present significant barriers to education [50]. Including Native culture and language in the classroom can help Alaska Native students be more successful and to continue education longer [50].
| A) | They are often over-represented in medical or mental health research. | ||
| B) | Some trials may involve invasive assessments or questioning contrary to cultural beliefs. | ||
| C) | Even when an attempt is made to include Native American subjects, inter-tribal diversity is not accurately reflected. | ||
| D) | Negative historical examples led to deeply seated fears and negative beliefs about research and have resulted in many Native people being unwilling to participate. |
Because American Indians and Alaska Natives make up a small percentage of the general population, they are often under-represented in medical or mental health research, and even when an attempt is made to include Native American subjects, inter-tribal diversity cannot be accurately reflected [1]. In 1993, legislation was passed in Congress to require more active recruitment of Native Americans in clinical trials. In the past, researchers have performed studies in Native communities without respect for or inclusion of the people themselves. These negative historical examples led to deeply seated fears and negative beliefs about research and have resulted in many Native people being unwilling to participate in research. Furthermore, some trials may involve invasive assessments or questioning contrary to cultural beliefs [44].
| A) | Climate change | ||
| B) | Spiritual punishment | ||
| C) | Geographical isolation | ||
| D) | Historical trauma, including the loss of culture |
With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:
Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.
Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.
Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.
Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.
Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve themselves in Native community events and encourage Native community involvement in treatment services.
Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.
Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.
Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.
Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.
| A) | Providers and administrators should avoid addressing their clients' cultural identity and related needs. | ||
| B) | Helping clients sever ties to their native cultures can help prevent and treat substance use and mental disorders. | ||
| C) | All American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. | ||
| D) | Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony. |
With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:
Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.
Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.
Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.
Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.
Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve themselves in Native community events and encourage Native community involvement in treatment services.
Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.
Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.
Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.
Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.
| A) | using native community vendors. | ||
| B) | hiring a workforce that reflects local diversity. | ||
| C) | offering professional development activities that highlight culturally specific American Indian and Alaska Native client and community needs. | ||
| D) | All of the above |
With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:
Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.
Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.
Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.
Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.
Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve themselves in Native community events and encourage Native community involvement in treatment services.
Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.
Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.
Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.
Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.