In rural Alaska, avoidance of dual relationships is impossible and may be culturally inappropriate; Alaska Native counselors live and work in communities where they are reared, educated, married, had children, and built their homes. These counselors have layers of relationships with relatives, friends and coworkers outside of the therapeutic alliance. In this study I interviewed six Alaska Native rural counselors and three clinical supervisors regarding the nature of their multi-faceted relationships, stressors of these on the counselor and ways of managing these stressors. Counselors stated that the multi-faceted relationships are a part of their daily life. They primarily manage these stressors through self-care techniques ranging from establishing clear boundaries to prayer and mediation to debriefing with a supervisor. Most Euro-American mental health professionals will never know the experience of counseling only their family and friends in the hometown where they were born and raised. However, for those counselors who live and practice in rural America this study should offer encouraging strategies for managing multi-faceted relationships.

It is well documented that Alaska leads the nation in alcohol dependence and abuse. There are studies that document the high abuse levels among Alaska Natives along with corresponding economic costs and lost productivity. The purpose of this study was: (a) to determine the definition of spirituality of a purposive sample of Athabascan Indians of Interior Alaska and (b) to discover what role spirituality plays in Athabascan recovery and sobriety. Nine life history interviews were examined from the People Awakening Project at the University of Alaska Fairbanks. A Grounded Theory Analysis was used to yield culturally relevant results. A definition of spirituality was determined and the role that spirituality plays in Athabascan recovery and sobriety was discovered. Athabascan recovery does not correspond entirely with traditional western treatment methods but there are some similarities in the recovery process common to both. Four of the nine interviews discussed attendance of AA groups or counseling as a help in their recovery. It is recommended that further study with other Alaska Native groups would be beneficial to identify protective and resiliency factors of spirituality and determine how to incorporate these factors for prevention of alcohol dependence.

Attachment between caregiver and child is an affectional, nurturing bond that develops through the provision of sensitive, constantly available, and responsive care for the child. The attachment bond evolves around diverse interactive experiences that encourage the development of cognitive-emotional schemata and the internalization of a cognitive-emotional working model of relationships. Different cultural experiences encourage the development of different cognitive-emotional schemata. Using a semi-structured interview, behavior, values, and the developmental endpoint associated with attachment was collaboratively explored with four Athabascan research participants, and concepts that emerged were compared and contrasted with those articulated by mainstream attachment theory within Western psychology. Attachment domains that emerged from triangulated interview data were (1) caregiver sensitivity, (2) trust development, (3) exploring, and (4) social competence. In mainstream attachment theory, one caregiver is the primary secure base for a child. Athabascan primary caregivers were a component of a larger community-wide secure base that included important secondary caregivers within a large kinship structure. In mainstream attachment theory, Western cultural values guide a social attachment process toward autonomy and self-direction for the individual. Athabascan community encourages values such as sharing of materials and community solidarity; an endpoint to the attachment process is instead social competence.

The purpose of this study was to determine the validity of a new assessment tool for Alaska Native clients with alcoholism. A sample of 23 Yup'ik clients at a regional treatment center were interviewed using the Drinker Inventory of Consequences for Alaska Natives (DrInC-AN), an adaption of the Drinker Inventory of Consequence (DrInC), the Alcohol Use Disorders Identification Test (AUDIT) and the Yup'ik Cultural Practices and Traditions (YCPT). These clients were selected, on a voluntary basis during the intake interview to the treatment center. Historically, assessment tools in alcoholism have not been culturally or linguistically sensitive to Alaska Native and Native American clientele. This study investigated the reliability and validity of the DrInC-AN in the assessment of severity of negative consequences of alcholol use among Alaska Natives.

The purpose of this study was to explore differences in eating disorder symptomatology among a matched sample of 100 Alaska Native/American Indian and Caucasian female university students, using a demographic instrument and the Eating Attitudes Test (EAT-26). Four (8.0%) Native participants and ten (20.0%) Caucasian participants met or exceeded the EAT-26 cutoff score indicative of clinically significant eating disorder symptomatology. There were no significant differences found among the Native and Caucasian participants with regard to eating disorder symptomatology. Rather, eating disorder symptomatology was present in both Native and Caucasian female college students at rates similar to that of previous studies.

The literature overwhelmingly demonstrates that play supports healthy social, emotional, physical, and cognitive development. Efforts to understand parents' support of child play seek to identify parent attitudes toward play, ways in which parents facilitate play for their children, and how they participate in play. Previous findings indicate parent valuation of play is an important factor for childhood play time and finds differences between mothers and fathers in parent-child play. While much research has been done to understand how mothers and fathers play with their sons and daughters, few studies have investigated what factors influence parent valuation of play or facilitate certain types of play. This study used a moderated mediation model to explore how parental attitudes about gender roles influence perceptions of play through parenting style and how this effect may be different for fathers and mothers. Analyses were also performed to understand the relationships between parent attitudes and parent play behaviors. The findings suggested egalitarian gender role attitudes predicted a higher valuation of play and more permissive mindsets toward cross-gender play for both mothers and fathers. Conversely, traditional gender role attitudes were predictive of less permissive mindsets toward cross-gender play for both mothers and fathers. A moderated mediation was found for fathers with traditional gender role attitudes and a permissive or authoritarian parenting style. Fathers with traditional gender role attitudes and a permissive parenting style were less likely to value play for child development. Fathers with traditional attitudes and an authoritarian parenting style had less permissive mindsets toward cross-gender play. Additionally for both mothers and fathers, authoritative parenting was correlated with increased parent play behaviors, while authoritarian parenting was correlated with decreased parent play behaviors. These findings support previous literature in that parent gender and gender role attitudes do appear to influence parent attitudes toward play. They also contribute to our understanding of parent gender differences and the way that parenting style influence this relationship. In addition, parenting style was found to be a facilitator of parent-child play. These findings contribute to an understanding of what kind of parents value play and can be used to inform family psychotherapy and parent education about play.

This study examined the validity of the Reasons for Life Scale (RFLS) with emerging adult college students. The RFLS measures "reasons for life." It was developed for use with Alaska Native youth as a way to assess potential risk of suicide without directly questioning about suicidal ideation or history of suicide attempts. This study sought to adapt the RFLS for use with emerging adult (age 18-25) college students, and to examine its factor structure and convergent validity with this population. First, a focus group was conducted to assist in rewording two Alaska Native-specific items from the RFLS for non-Natives. Then, with the additional items from the focus group, the revised version of the RFLS (RFLS-R) and other suicide-related measures were administered to a sample of 116 emerging adult college students. Exploratory factor analysis indicated a unidimensional factor structure for the RFLS-R with this sample. The RFLS-R showed a significant and strong correlation with the Reasons for Living Inventory (RLI; r = .70), which, like the RFLS-R, measures reasons for living but makes direct reference to suicide. There also were significant moderate negative correlations with the Suicidal Behavior Questionnaire - Revised (SBQ-R; r = -.36) and the Adult Suicidal Ideation Questionnaire (ASIQ; r = -.29). There was a significant moderate correlation between the RFLSR and a measure of socially desirable responding, the Balanced Inventory of Desirable Responding (BIDR; r = .31), with similar correlations found between the BIDR and other suicide-related measures included in this study. The results suggest that socially desirable responding did not strongly affect participants' responding or explain the associations found among the measures. The high correlation with the RLI suggests that the RFLS-R measures a similar construct, providing evidence of convergent validity; however, the RLI was more highly correlated with measures of suicidality than the RFLS-R -- suggesting that while the RFLS was moderately associated with measures of suicidality, it is a weaker predictor of suicide risk than the RLI. Although the RFLS-R was not as highly correlated with measures of suicidality as the RLI, which directly mentions suicide, the RFLS-R is the only known suicide measure that completely avoids items and instructions that mention suicide, therefore it may be useful in contexts where directly discussing suicide is not acceptable or appropriate.

The aim of this study is to explore strategies for navigating challenges in a rural Alaskan Yup'ik community among youth and young adults. This qualitative study captures a longitudinal perspective as youth (N=25; 11 -18 years old) were originally interviewed in January 2010. For the current study, participants were re-interviewed in December 2012. Follow-up interviews addressed life challenges over the past three years and resources that helped them with their hard times. To reinforce the multifaceted nature of growing-up in a rural Yup'ik community, scholarly literature along with observations, conversations with local residents, and local wisdom captured in anthropological work are featured throughout this paper. Fifteen youth (14 years old - 20 years old) agreed to be re-interviewed. Developmental changes were noted regarding challenges and protective resources. Youth emphasized challenges as sources of vulnerabilities around lack of employment and interpersonal relationship strain. Similar to findings from the original study, interpersonal relationship distress was discussed in three distinct contexts including antagonist "girl drama," family discord, and partner relations conflicts. Youth identified personal strengths such as re-framing challenges, seeking personal space, and family support to overcome challenges. Contemporary understanding of emergent young adults' role and responsibilities in a rural Yup'ik setting warrants further study as it was found to be a source of vulnerability. Findings can inform clinical and prevention work in the community. For example, targeted community activities can address reported challenges including job fairs and workshops on healthy relationships with specificity to the experience of becoming an adult in rural Alaska.

Colorectal cancer (CRC) incidence and mortality among Alaska Native people are the highest of any ethnic or racial group in the United States. First-degree relatives (FDRs), which include parents, siblings, and children of CRC patients, are at increased risk. There is a paucity of data on predictors of screening adherence among Alaska Native FDRs, and the extent to which screening outreach is occurring within the Alaska Tribal Health System (ATHS) for FDRs. There is also a lack of data available on barriers and facilitators to increasing screening outreach efforts in this population. This study assessed the prevalence of CRC screening outreach to FDRs at Alaska tribal health organizations (THOS), use of family history information, barriers to CRC screening, and potential tools to improve CRC screening throughout the Alaska Tribal Health System (ATHS). The study also included a process evaluation of the Alaska Native CRC Family Outreach Program (2000-2012) based in Anchorage, Alaska. The process evaluation investigated the program's formation, evolution, and successes and challenges through a series of key informant interviews with program stakeholders. Lastly, an outcome evaluation was conducted of the Alaska Native CRC Family Outreach Program to assess predictors of screening adherence and results of screening among Alaska Native FDR program participants. The study found that CRC screening outreach was common in the ATHS, but significant barriers still exist. These barriers were especially notable for outreach to FDRs, including a lack of dedicated staff and resources. Key results of the process evaluation of the Alaska Native CRC Family Outreach Program included an incremental approach that led to a unique outreach program and revealed the need for dedicated staff to provide culturally competent patient navigation. Challenges identified included differing FDR outreach responses, health system data access and coordination, and relying on unstable grant funding for program sustainability. The outcome evaluation of the Alaska Native CRC Family Outreach Program found despite increasing programmatic outreach and FDR screening rates, a large proportion of Alaska Native FDRs were still due for screening. This was especially true among rural-dwelling and older FDRs. This study found that overall, CRC screening and awareness are increasing among the Alaska Native population, including among FDRs. However, many Alaska Native FDRs remain unscreened. There is a critical need for more research into FDR barriers and facilitators to CRC screening, as well as how the ATHS can more systematically promote screening among this increased-risk population and reduce morbidity and mortality due to this preventable disease.