Physical and Mental Health
AI/AN youth aged 15-25 face serious health disparities in multiple areas, including suicide, obesity, type 2 diabetes, and substance abuse.1 In 2010, nearly 30 percent of AI/ANs lacked health insurance and relied solely on the Indian Health Service (IHS), and currently only one in five AI/ANs have access to the IHS, including mental health services.2
AI/ANs overall have the highest rate of type 2 diabetes in the United States, and it is becoming increasingly common among AI/AN youth. The diabetes rate among AI/AN youth aged 15-19 increased 68 percent between 1994 and 2004.3
Many of the health disparities that affect AI/AN youth overall health also affect their mental health. While research is limited, available data suggest that AI/AN youth and adults disproportionately suffer from the burden of mental health problems and disorders. Risk factors contributing to poor mental health among AI/AN people include high rates of poverty, violent victimization, substance abuse, historical trauma, and lack of health insurance and access to appropriate mental health care to address these issues, among other factors. Today, the most significant mental health concerns for the AI/AN population are high prevalence of depression, substance use disorders, suicide, anxiety, and post-traumatic stress disorder.4
Substance Use Issues
Due to cultural and geographic diversity of AI/ANs, tobacco use often varies widely by region and subgroup. However, lung cancer is the leading cause of cancer death among AI/ANs.5 AI/AN youth aged 12-17 have the highest prevalence of smoking compared with other racial and ethnic populations.6
Additionally, alcoholism mortality is 514 percent higher in the overall AI/AN population compared to the general population. More than 22 percent of AI/AN youth aged 12 and older report alcohol use, and more than 16 percent report binge drinking and other substance use issues. Increased methamphetamine use is also a concern among the AI/AN population.7
An example of a successful program focused on AI/AN youth with substance use issues is the Cherokee Talking Circle (CTC) of the United Keetowah Band of Cherokee Indians in Oklahoma. CTC is a culturally based intervention with the main goal of reducing substance abuse and with, “…abstinence [from substance use] as an ideal outcome.” The program includes Keetowah-Cherokee values and integrates the Cherokee concept of self-reliance and, “…their overall worldview that all things come together to form a whole.” In comparison with other standard substance abuse programming, CTC has been found to be significantly more effective in reducing substance use and other related problem behaviors among AI/AN youth.8
AI/AN youth have the highest suicide rate of any cultural or ethnic group in the United States.9 Compared to other racial/ethnic groups, the rate of suicide among AI/AN males aged 15-25 is four times higher and AI/AN females is up to 11 times higher.10 In the U.S., 11-20 percent of AI/AN youth report attempting suicide each year.11
There are several federal cross-agency collaborations and resources that aim to promote effective suicide prevention efforts in AI/AN communities. The Substance Abuse and Mental Health Services Administration provides a comprehensive and user-friendly resource, Promoting Suicide Prevention Efforts in American Indian/Alaska Native Communities: A Cross-Agency Approach (PDF, 1 page), that details these efforts and includes telehealth resources and activities, and resources and tools.
An example of a program that is focused on suicide prevention is the American Indian Life Skills Development program, also known as Zuni Life Skills Development. The program is customized to AI/AN norms and values and was designed to reduce behavioral and cognitive factors associated with suicidal thinking and behavior. Program outcomes have shown that intervention students demonstrated significantly higher levels of suicide intervention skills and problem-solving skills than the non-intervention group.12
Injuries and violence are the leading causes of death of Native American children and youth, accounting for 75 percent of all deaths among one to 19 year olds. Injury mortality data from 1989 through 1998 for AI/AN youth show motor vehicle and pedestrian accidents and suicide were highest in deaths from injury among this group.13
AI/AN youth have the third highest birth rate in the U.S. Between 2005 and 2007, the birth rate among AI/AN teens increased 12 percent, more than twice the national increase and more than any other racial/ethnic group. While there is little information available about AI/AN youth on sexual behavior and contraception use, available data suggests AI/AN girls are more likely to engage in sexual intercourse before the age of 16 and less likely to have used contraception the last time they had sex compared to other teens.14
The Personal Responsibility Education Program (PREP) is a funding opportunity for Native American communities from the Family and Youth Services Bureau (FYSB). The grant program focuses on teen pregnancy prevention and is designed to help prepare young people in their transition to adulthood. PREP is based off of evidence-based interventions that have been shown to be effective in changing behavior. FYSB conducted public consultations with more than 150 people from more than 30 tribes and it was found that representatives strongly supported the design of programs at the local level, “where individual community needs and cultural values can be reflected.” By 2011 there were 16 tribal organizations that were implementing PREP in their communities. First year grantees were from: Alabama, Arizona, California, Michigan, North Dakota, New Mexico, Oklahoma, Oregon, and South Dakota.15
Poverty, poor education, and inequality, and movement from rural to urban environments are risk factors that impact trafficking for AI/AN youth. Each of these risks combine with other factors such as lack of adequate criminal justice infrastructure to meet the needs of Indian country and a scarcity of social services for victims makes addressing the problem especially daunting.
An evaluation of trafficking services for AI/AN girls and women at the Minnesota Indian Women’s Resource Center discovered four key lessons about working with this population.
- Routinely asking AI/AN girls who are entering harm reduction programs if they have ever been involved in trading sex often opens up conversation about commercial sexual exploitation and trafficking.
- Utilizing outreach efforts at schools to link at-risk girls to, “culturally grounded, trauma-centered, long-term support” is vital. This can include providing healthy sexuality education and confidential support groups where the students can learn about trafficking and recruiting methods. Additionally, it is a place where an at-risk student can quickly be transitioned to intensive case management if necessary.
- The importance of patience in working with this population over a long period of time. It can take some girls as long as two years to be able to recognize or admit that they have been trafficked.
- Lastly, those who work with this population need to practice intensive self-care. This can include exercise, healthy eating, participating in nature, weekly staff meetings to discuss challenges, and staff trainings on self-care and stress management.16
Native American youth are at a greater risk for homelessness.17 They have disproportionate representation in homeless shelter and transitional living programs.18 There has been difficulty in getting an accurate assessment of how many Native American Alaska Native youth are homeless due to issues such as inadequate rural outreach, government mistrust, and varying definitions of homelessness in tribal communities. Additionally, homeless Native American youth may not fit the federal definition of homeless, which can further prohibit them from accessing human services.19
Host Home Programs are an innovative way to provide housing for homeless AI/AN youth. The Family and Youth Services Bureau (FYSB) has been supporting grantees that utilize the host home model to support runaway youth and homeless youth programs. This model has been particularly helpful for those in rural areas because it is a more practical option than typical short-term shelters and long-term transitional housing.20 FYSB provides an overview of how to get started in creating a Host Home Program for Native youth.
American Indian/Alaska Native Youth and Teen Pregnancy Prevention (PDF, 16 pages)
The National Campaign to Prevent Teen and Unplanned Pregnancy discusses AI/AN teen pregnancy rates, risk factors, and available programs to prevent teen and unplanned pregnancy among Native youth.
American Indian and Alaska Native: Tribal Affairs
This section of the SAMHSA website provides resources on the AI/AN population, including national survey reports, agency and federal initiatives, and related behavioral health resources.
CDC: American Indian and Alaska Native Populations
The CDC’s American Indian and Alaskan Native Populations webpage provides the latest data and statistics for the AI/AN population, including demographics, leading causes of death, and other important health issues.
Collaborating with Native Americans and Alaska Natives
The White House and Office of National Drug Control Policy provides information on drug use among Native American and Alaska Native youth.
Federal Strategic Action Plan on Services for Victims of Human Trafficking (PDF, 84 pages)
This President’s Interagency Task Force to Monitor and Combat Trafficking in Persons report describes the three primary strategies for addressing human trafficking (prevention, awareness, and services for survivors) and activities that will be implemented by the U.S. Department of Health and Human Services’ Administration for Children and Families to improve outcomes for survivors.
Indian Country Child Trauma Center
The Indian Country Child Trauma Center (ICCTC) was established to develop trauma-related treatment protocols, outreach materials, and service delivery guidelines specifically designed for AI/AN children and their families.
Risk and Protective Factors for Substance Use Among American Indian or Alaska Native Youths (PDF, 18 pages)
This document by SAMHSA is an inventory of current studies on risk and protective factors on substance abuse among AI/AN youth.
Suicide Prevention Resource Center: American Indian/Alaska Native Youth
This website provides resources and knowledge specific for AI/AN populations to support suicide prevention and mental health promotion.
To Live To See The Great Day That Dawns: Prevention Suicide by American Indian and Alaska Native Youth and Young Adults (PDF, 184 pages)
This guide from SAMHSA was created to help AI/ANs develop effective and culturally appropriate suicide prevention programs.
Urban American Indian and Alaska Native Youth (PDF, 32 pages)
This report from the Urban Indian Health Institute includes a review of the urban AI/AN youth population and their health risk behaviors from national data sources.
We R Native
We R Native is a comprehensive health resource for Native youth, by Native youth. We R Native strives to promote holistic health and positive growth in local communities and nationwide.
1 Native American Youth 101, n.d.
2 Fast Facts: Native American Youth and Indian Country, 2014
3 Native American Youth 101, n.d.
4 Mental Health Disparities: American Indians and Alaska Natives, 2014
5 Centers for Disease Control and Prevention, 1998
6 Hutchinson & Shin, 2014
7 Native American Youth 101, n.d.
8 OJJDP, 2016
9 To Live To See The Great Day That Dawns: Prevention Suicide by American Indian and Alaska Native Youth and Young Adults, 2010
10 Native American Youth 101, n.d.
11 Fast Facts: Native American Youth and Indian Country, 2014
12 OJJDP, 2016
13 Centers for Disease Control and Prevention, 2006
14 American Indian and Alaska Native Youth and Teen Pregnancy Prevention, 2009
15 Family & Youth Services Bureau, n.d.
16 Pierce, 2012
17 U.S. Interagency Council on Homelessness, n.d.
18 Family & Youth Services Bureau, 2014
19 Housing Assistance Council, 2013
20 Family & Youth Services Bureau, 2006
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