American Indian and Alaskan Native lesbian, gay, bisexual, transgendered, and two-spirited individuals (two spirits) are a drastically understudied and underserved group, at risk for multiple health and mental health problems. There are no national, quantitative, representative studies of this population on any topic. This application, in response to PA-01-096, is for a FIRST TIME R01 by a NEW INVESTIGATOR. Building upon solid preliminary data, it proposes three innovative and significant aims. First, we will conduct structured survey interviews with 400 two spirits drawn from six sites across the U.S. With these interview data, we will test a theoretical model of stress and coping specific to this population. Sub-aims are to (a) establish preliminary prevalence rates of trauma and health outcomes (i.e., HIV sexual risk behaviors, alcohol and other drug use, and mental health indicators); (b) test the direct associations between trauma and health outcomes; (c) determine how cultural and spiritual coping factors moderate the effect of trauma on health outcomes; and (d) examine the mediating role of substance use on the trauma-HIV sexual risk behavior and trauma-mental health relationships.
The second aim i s to test the, feasibility of an innovative non-probability sampling methodology that combines targeted, partial network, and respondent-driven sampling procedures in order to approximate a representative national sample of two spirits. Additionally, we will test the feasibility of two different mechanisms (agency based vs. census based) by which we execute this sampling method. Our results will contribute toward the refinement of a sample strategy useful in studying other hidden and stigmatized populations. Our third and final aim is to conduct a qualitative study involving 12 focus groups and 60 key informant interviews in order to identify emergent themes regarding stressors and coping strategies specific to two spirits. Through the course of this project, we aim to develop the research infrastructure at the six community agencies comprising our participant recruitment sites in order to facilitate future goals of designing and evaluating interventions to address the urgent needs of two spirits.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH065871-04
Application #
6889310
Study Section
Special Emphasis Panel (ZRG1-AARR-7 (01))
Program Officer
Forsyth, Andrew D
Project Start
2002-06-28
Project End
2007-05-31
Budget Start
2005-06-01
Budget End
2006-05-31
Support Year
4
Fiscal Year
2005
Total Cost
$396,726
Indirect Cost
Name
University of Washington
Department
Type
Schools of Social Work
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Town, Matthew A; Walters, Karina L; Orellana, E Roberto (2018) Discriminatory distress, HIV risk behavior, and community participation among American Indian/Alaska Native men who have sex with men. Ethn Health :1-13
Johnson-Jennings, Michelle D; Belcourt, Annie; Town, Matthew et al. (2014) Racial discrimination's influence on smoking rates among American Indian Alaska Native two-spirit individuals: does pain play a role? J Health Care Poor Underserved 25:1667-78
Yuan, Nicole P; Duran, Bonnie M; Walters, Karina L et al. (2014) Alcohol misuse and associations with childhood maltreatment and out-of-home placement among urban two-spirit American Indian and Alaska Native people. Int J Environ Res Public Health 11:10461-79
Evans-Campbell, Teresa; Walters, Karina L; Pearson, Cynthia R et al. (2012) Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/Alaska natives. Am J Drug Alcohol Abuse 38:421-7
Nelson, Kimberly M; Simoni, Jane M; Pearson, Cynthia R et al. (2011) 'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. Ann Behav Med 42:370-80
Lehavot, Keren; Walters, Karina L; Simoni, Jane M (2009) Abuse, mastery, and health among lesbian, bisexual, and two-spirit American Indian and Alaska Native women. Cultur Divers Ethnic Minor Psychol 15:275-84
Walters, Karina L; Simoni, Jane M (2009) Decolonizing strategies for mentoring American Indians and Alaska Natives in HIV and mental health research. Am J Public Health 99 Suppl 1:S71-6
Walters, Karina L; Evans-Campbell, Teresa; Simoni, Jane M et al. (2006) ""My spirit in my heart"": identity experiences and challenges among American Indian two-spirit women. J Lesbian Stud 10:125-49
Duran, Bonnie; Walters, Karina L (2004) HIV/AIDS prevention in ""Indian country"": current practice, indigenist etiology models, and postcolonial approaches to change. AIDS Educ Prev 16:187-201