This Tribal Community-Engaged project uses spatial and legal epidemiological methods within community participatory frameworks to assess the differential relationships of state and tribal alcohol policies to alcohol- related health risks for residents of American Indian reservations. We propose to compile and summarize alcohol regulatory policies established by sovereign tribal nations in conjunction with extant alcohol policies of the U.S. states with which they are collocated. Many correlates of the high rates of alcohol-related problems observed among American Indians (AI) compared to other U.S. populations have been extensively addressed in individual social-behavioral studies in, for example, genetics, psychology, and community health. Very few studies have considered contrasting state vs. tribal alcohol policies as social-structural determinants that may be related to AI alcohol related problems. Sovereign tribal nations have the right to establish their own alcohol policies, which may vary according to adjacent state policy conditions and attitudes towards alcohol across tribal communities. Tribal alcohol policies are publicly registered, but there has been no common repository nor systematic typology established that allows researchers to characterize these ordinances and relate them to state alcohol conditions (see, e.g. NIAAA?s Alcohol Policy Information System). Prior studies of tribal alcohol policies were not able to consider the full impacts of collocated state alcohol regulatory conditions on tribal alcohol problems. Recent studies have developed an Alcohol Policy Score (APS) that characterizes the strengths of alcohol policies across U.S. states. The APS may now be applied to studies of tribal alcohol regulatory conditions. Cross-site studies of tribal alcohol outcomes have also been hampered by the use of heterogenous data systems. We demonstrate that hospitalization records and motor vehicle crash data collected in similar ways across U.S. states can be used to assess tribal alcohol outcomes using common data frames and advanced spatial epidemiological methods. Finally, analyses of tribal policies will be limited in interpretive scope without obtaining local insights and knowledge of tribal leaders who have designed, enacted, and are charged with enforcing tribal alcohol ordinances. We use Tribal Community-Based Participatory and qualitative research methods at multiple levels of community engagement (Tribal Community Advisory Board; tribal research review; Tribal Key Leader Interview; Tribal and Local Law Enforcement Survey) to assess how tribal and state alcohol policies are effected on tribal lands and may support or reduce alcohol-related risks for residents of tribal nations. Our engagement plans ensure tribal community oversight of the interpretation of findings, and dissemination of results to tribal leaders as well as scientific communities.
This study will support spatial and legal epidemiological research that will (1) summarize tribal alcohol policies across 56 tribal nations collocated in 13 US states, (2) perform qualitative and quantitative studies of the local contexts and enforcement implementation of alcohol policies across these 56 tribal nations, and (3) assess relationships of state and tribal alcohol policies to alcohol related health outcomes using hospital discharge and traffic injury data. For communities experiencing stark health inequities, the tribal alcohol policy measures developed in this project will increase capacity for policy making, provide opportunities for culturally and contextually-tailored health policy research interventions, create collaborative knowledge for multiple jurisdictions, and support jointly constructed solutions to public health problems. Results will advance methods for understanding alcohol regulation and measures of population health among communities experiencing some of the most disparate health inequities in the United States, demonstrate the utility of including community voices to enrich our empirical assessments of contextual factors associated with alcohol-related outcomes, and support community advocacy for policy change by improving understanding of policy effects on health outcomes.
