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FOCUS ON CIVILIZATIONS AND CULTURES
INDIGENOUS PEOPLES
PERSPECTIVES, CULTURAL ROLES
AND HEALTH
CARE DISPARITIES
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FOCUS ON CIVILIZATIONS AND CULTURES
INDIGENOUS PEOPLES
PERSPECTIVES, CULTURAL ROLES
AND HEALTH
CARE DISPARITIES
JESSICA MORTON
EDITOR
New York

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CONTENTS
Preface vii
Chapter 1 Brazilian Indigenous Peoples:
History, Challenges, Threats and Conquests 1
Eunice M. L. Soriano de Alencar and
Nívea Pimenta Braga
Chapter 2 Children’s Skills, Expectations and Challenges
Facing Changing Environments: An Ethnographic
Study in Mbya Indigenous Communities (Argentina) 31
Carolina Remorini
Chapter 3 Tradition and Transformation of Eastern James Bay
Eeyou (Cree) Foodways in Pregnancy:
Implications for Health Care 71
Helen Vallianatos and Noreen Willows
Chapter 4 Disparities in Medication Use among
Elder American Indians:
Evidence, Causes, and Implications 105
Jane R. Mort and Chamika Hawkins-Taylor
Chapter 5 Mental Health Disparities, Historical Realities,
and Sociocultural Barriers of American Indians
and Alaska Natives:
A Focus on Suicide Prevalence and Prevention 133
Paula T. McWhirter and Elizabeth Terrazas-Carrillo
Index 173

PREFACE
In this book, Chapter One addresses the diversity of Brazilian indigenous

peoples, their history, and basic elements of distinct ethnic groups, such as
their languages, social organization, rituals, myths, values, habits, and artistic
expressions. Chapter Two describes some settings in which children learn
about their way of life, in the framework of interactions with peers and more
experienced people. It also explores how drawings and models made by
children can tell stories about children´s preferences, expectations and future
horizons, and reflects on how intergenerational and peer interactions involve
transmission, adaptation, questioning and innovation of knowledge and skills
necessary to dwelling in changing environments. Chapter Three provides a
picture of mid-20th century lifestyle practices of Eeyou women when pregnant
and breastfeeding with the aim to provide information that could potentially be
used to improve culturally competent prenatal and postnatal care for Eeyou
women. Chapter Four discusses disparities in medication use among elder
American Indians. Chapter Five provides a conceptual overview of mental
health disparities, historical realities, and sociocultural barriers of American
Indians and Alaska natives.
Chapter 1 - The chapter addresses initially the diversity of Brazilian
indigenous peoples, their history, and basic elements of distinct ethnic groups,
such as their languages, social organization, rituals, myths, values, habits, and
artistic expressions. It also underlines the existence of native peoples still
isolated, that resist contact, and others that have been increasingly integrated
into the Brazilian society. The drastic decline of the indigenous population
since the first European contact in 1500 when the Portuguese arrived in Brazil
is highlighted, pointing out factors that contributed to the extermination of the
majority of their communities. The paper maps the indigenous peoples’

viii Jessica Morton
valuable contributions to the country's culture, besides examining some

challenges faced nowadays by these peoples in contact with the dominant
society, as well their struggles to maintain the rights already attained. Data
obtained through interviews and testimonials from professionals who work
with indigenous peoples are presented to illustrate some of the topics
addressed.
Chapter 2 - Mbya Guarani are one of the Indigenous peoples living in the
Argentinian Northeast in the southern extension of the Paranaense Rainforest,
one of the major areas of biodiversity in South America. However, during the
last decades the Paranaense Rainforest has been under several pressures which
has significantly reduced its extent and has led to major changes in Mbya way
of life (Mbya reko). Mbya people are acknowledged for their deep relationship
with the forest. The transformations in the forest are seen as the main cause of
the discontinuity in the acquisition of culturally relevant knowledge and skills.
This issue is often a recurring theme in the speeches of elderly leaders who
claim for the recovering of spheres for learning the Mbya reko.
Facing these speeches that emphasizes the generational discontinuity in
cultural learning, the authors’ ethnographic study accounts for the vitality of
knowledge and skills highly valued in the context of the Mbya way of life. In
other words, children’s engagement in routine subsistence activities, which
present a high potential for learning of local knowledge and for the process of
enskillment, continue to be predominant. These processes are directly linked
with the individual’s involvement in their environment, throughout careful
observation and participation in activities performed by multi-aged groups of
people. In this framework, “traditional” knowledge and practices are not only
reproduced but also continuously transformed in creative ways. However,
Mbya children also engage in other activities such as school or entertainment,
which are considered “non-traditional.”
The data analyzed in this chapter come from observations, interviews,
drawings and models produced by children from Mbya communities.
Considering this background, this chapter first describes some settings in
which children learn about their way of life, in the framework of interactions
with peers and more experienced people. Second, it explores how drawings
and models made by children can tell stories about children´s preferences,
expectations and future horizons. Finally, the chapter reflects on how
intergenerational and peer interactions involve transmission, adaptation,
questioning and innovation of knowledge and skills necessary to dwelling in
changing environments. Moreover, how elderly knowledge and advice are
acknowledged by children and young people for exploring new opportunities

Preface ix
in the globalized world. Based on that, the authors discuss elders’ ideas about
the discontinuity of learning and stress the relevance of taking into account
perspectives of both children and youth to understand the contemporary Mbya
way of life in the framework of ecological changes.
Chapter 3 - Many Eeyou (Cree) women living in the James Bay region of
Quebec experience excess weight gain in pregnancy, and retain weight
between pregnancies, contributing to obesity related health problems. Health
practitioners might be better able to advise Eeyou women on healthy diets and
physical activity if conversant with Eeyou history and traditions. The authors
provide a picture of mid-20th century lifestyle practices of Eeyou women
when pregnant and breastfeeding with the aim to provide information that
could potentially be used to improve culturally competent prenatal and
postnatal care for Eeyou women. The research consisted of (1) a literature
review that documented how Eeyou lifeways have changed as a result of
European colonization, and (2) qualitative interviews with ten Eeyou Elders
who had borne their children at a time when people still lived in the bush. The
literature review and thematic analysis of Elder interviews showed that
colonization by Europeans led to profound changes in the lifeways of Eeyou
women, through the rapid transformations of cultural traditions, physical
activity patterns and foodways. Still, even today the “bush” is seen as a
healing place. Elders had concerns about changing foodways, as traditional
Eeyou food acquired from hunting, fishing and gathering is considered as vital
for a sense of Eeyou identity. Elders focused on the shift away from a
traditional subsistence life as the reason why so many women faced weight
challenges. Elders’ perceptions of appropriate quantities and types of food that
women should consume were apt for a time when people lived a physically
active life in the ‘bush,’ different from contemporary, sedentary lifestyles
experienced by many women. Thus, not all advice provided by Elders would
be appropriate in today’s food environment. The information the authors
provide could help frame health advice for contemporary Eeyou women in
their reproductive years. Based on the cultural importance and nutritional
significance of Eeyou food, a strategy to promote wellness among Eeyou
women might be the consumption of traditional food in combination with
healthy Western foods. Furthermore, bush spaces such as hunting camps might
be culturally appropriate healing spaces to hold prenatal and postnatal
programs. Health promotion strategies must be respectful of the fact that not
all women will like Eeyou food, have time to prepare it, or consider eating it as
integral to their sense of identity. Women must decide for themselves what

x Jessica Morton
their particular worldview will encompass about Eeyou traditions and

modernity in the 21st century.
Chapter 4 - Elder American Indians account for 9% of all American
Indians and 1% of all US elders (65 years and older). American Indian
elders suffer poorer health, greater functional disability, and a shorter life-
span compared to the general US population. Poor health in the form of
multiple chronic conditions accounts for unique medication use issues.
However, little research exists on medication use and prescribing practices
for American Indian elders. Currently available medication use data
addresses polypharmacy, potentially inappropriate medication (PIM) use, and
management of select conditions common to American Indians. Many of these
studies are limited by lack of a comparator group, small sample sizes, specific
health care settings, and amount of time that has transpired since data
collection (1993 to 2009). However, this literature indicates American Indian
elders frequently receive polypharmacy (four or more medications), have
twice the odds of receiving a PIM, and often receive suboptimal therapy for
diabetes, lipid management, and asthma.
Health disparities which have been clearly identified for various minority
groups help to explain the differences in medication use practices for
American Indian elders. Yet limited research exists on health disparities
for American Indian elders. For this chapter, 25 prescription medication
use issues that may potentially result in health disparities are organized
into six categories: access, social support, patient characteristics, health
beliefs/behaviors, health status, and prescribing behaviors. Published data
related to these factors among American Indian elders provides some insight
into the cause of disparities. However, further research is needed to understand
the impact of these issues.
While limited information is available on medication use patterns in the
American Indian elder population, it appears that disparities exist. Focused
efforts are necessary to optimize the management of disease in this population.
However, well designed research is required to create approaches that best
meet the needs of this population.
Chapter 5 - American Indians and Alaska Natives (AI/AN) have
experienced profound sociopolitical and economic hardship, characterized by
a history of colonialism and racial oppression. These experiences have resulted
in higher prevalence rates across a broad range of mental health difficulties,
including depression, posttraumatic stress disorder (PTSD), anxiety, substance
use disorders, and suicide, as compared to the general U.S. population (Beals
et al., 2005; IHS, 2015). In this chapter, the authors provide a conceptual

Preface xi
overview of the current state of the problem. The authors begin by providing a
framework for understanding these mental health disparities, including
discussion regarding interpretations (material vs. psychosocial) designed to
enhance the authors’ understanding of this phenomena, followed by a
description of latent, pathway, cumulative and latent effects of disparities
across the lifespan. The authors then review current research, including
comparisons of lifetime prevalence rates for a variety of mental health
consequences across AI/AN communities. In order to enhance the authors’
understanding of these disparities, the authors focus on suicidality, which
represents one of the greatest discrepancies experienced among AI/AN
individuals, and the leading cause of death due to mental health difficulties.
Next, the authors critically examine risk and protective factors known to
impact suicidality and other mental health disparities across AI/AN
communities. This is followed by a discussion of the complex relationship
between risk and protective factors, which provides a foundation for the
authors’ recommendations. Finally, the authors conclude with an examination
of indigenous epistemologies and cultural competence to prevention and early
intervention that promote social justice within these communities.

In: Indigenous Peoples ISBN: 978-1-63485-657-7
Editor: Jessica Morton © 2016 Nova Science Publishers, Inc.
Chapter 1
BRAZILIAN INDIGENOUS PEOPLES:

HISTORY, CHALLENGES, THREATS
AND CONQUESTS
Eunice M. L. Soriano de Alencar

and Nívea Pimenta Braga *
University of Brasilia, Brazil
ABSTRACT
The chapter addresses initially the diversity of Brazilian indigenous
peoples, their history, and basic elements of distinct ethnic groups, such
as their languages, social organization, rituals, myths, values, habits, and
artistic expressions. It also underlines the existence of native peoples still
isolated, that resist contact, and others that have been increasingly
integrated into the Brazilian society. The drastic decline of the indigenous
population since the first European contact in 1500 when the Portuguese
arrived in Brazil is highlighted, pointing out factors that contributed to
the extermination of the majority of their communities. The paper maps
the indigenous peoples’ valuable contributions to the country's culture,
besides examining some challenges faced nowadays by these peoples in
contact with the dominant society, as well their struggles to maintain the
rights already attained. Data obtained through interviews and testimonials
*
Corresponding Author address: Eunice M. L. Soriano de Alencar, SHIS QL 10, conjunto 6, casa
14, 71630-065 Brasília, DF, Brasil. Email: eunices.alencar@gmail.com.

2 Eunice M. L. Soriano de Alencar and Nívea Pimenta Braga
from professionals who work with indigenous peoples are presented to

illustrate some of the topics addressed.
Keywords: Brazilian indigenous diversity, Brazilian indigenous conquests,

Brazilian indigenous struggles, indigenous rituals
INTRODUCTION
Brazil is a country known internationally by the mixture of cultures that
define the habits, customs and traditions. The formation of the Brazilian state
is the result of a complex amalgam of peoples predominantly Indigenous,
African and Portuguese (Baraldi et al., 2011).
Indigenous were the peoples who inhabited Brazilian lands when the
Portuguese navigators arrived in 1500. It was in this year that the Portuguese
colonization was initiated, marked by exploitation, slavery, war and even
destruction of a significant portion of the native populations.
Freyre (2003) highlights that the Brazilian colonization presents distinct
traits when compared to the others that occurred in Latin America during the
same period. Unlike the massive dominance of European culture which
prevailed in Argentina, Uruguai, Paraguai as well as Chile, or the
confrontation of races, which marked the occupation in Mexico and Peru, the
idea of cultural amalgam is commonly associated when referring to Brazil.
The concept of acculturation is frequently used to describe the interaction
between Portuguese and Indians. In fact, many elements still in use nowadays
in Brazil were inherited from the indigenous peoples, such as foods, home
medicines, kitchen utensils and hygiene habits, such as the daily bath, not to
mention the use of the red color, the celebration of life through the songs and
dances, the name of fruits, rivers and animals.
However, the decimation of entire ethnic groups and the reduction of so
many others show that the contact, in general, was quite aggressive. Amoroso
(1998) points out that, despite the recommendation to treat the Indian “with
affability,” registered in Portuguese documents, in practice, the colonizers’
actions were contrary to the modus vivendi established and practiced among
the indigenous peoples for generations. The practice of settling the indigenous
people, of changing deeply their habits, of forcing their conversion to
Catholicism and of demanding hard work were harsh forms of dealing with the
native. These actions were measures that went against the primitive culture

Brazilian Indigenous Peoples 3
already established. To these practices, others followed throughout the 20th

century, whenever justified by an alleged cultural superiority of the white man.
This chapter presents an overview of several topics related to the Brazilian
indigenous peoples. It focuses primarily on: (a) history of the Brazilian
indigenous peoples, their origin and the impact of the colonizers’ presence on
their lives and culture; (b) the enormous diversity concerning to language,
rituals, myths, practices and artistic expressions among the indigenous nations,
as well as their common characteristics; (c) challenges and conquests of the
indigenous peoples in contact with the dominant society immersed in a
continuous technological progress; (d) the indigenous peoples’ conquests and
struggles in respect to their rights as Brazilian citizens.
BRAZILIAN INDIGENOUS PEOPLES:

HISTORICAL BACKGROUND
In 1500, when Portuguese navigators in course to India docked in lands of
South America, they found human groups that, since then, have been referred
to as “Indians,” designation given to the inhabitants of the New World by
European navigators. The creation of the term is attributed to Christopher
Columbus, once the Genovese navigator initially believed to have reached
Asiatic India’s land when his ships docked at America in 1492. Todorov
(2003) underlines that Columbus’ euphoria at discovering new lands was such,
that the expeditionary seemed to be taken by a “nominative furor,” dedicating
good part of his time in looking for names to designate everything that was
being found.
The initial thinking of the Portuguese was also that they had landed in
India. Even after finding out the mistake and realizing that they had not
docked at Asian lands but at a new continent, they continued calling the people
of the new lands as Indians (Melatti, 2007).
No one knows for sure the number of inhabitants in Brazil, when the
Europeans arrived in the early 16th century. Different estimations are offered
by several authors, with the variation between 1.1 million (Stewart quoted by
Melatti, 2007) and 11 million natives (www.survivalinternational.org/tribes/
brazilian), but it is more frequently supposed to be between 5 to 10 million
individuals (Zarur, 2000). Only in the Brazilian Amazon region, there is
estimation, based on archaeological research, that 3 to 5 million indigenous
people inhabited this region on the occasion of the arrival of the Portuguese

conquerors (Loebens and Carvalho, 2005). Similarly, it is not known precisely

the number of indigenous nations to which these people belonged, although it
is estimated to be superior to 1000 nations (Zarur, 2000), and may even reach
2000 nations.
The origin of the inhabitants living in Brazil in 1500 is remote, according
to evidence indicating that the country was inhabited in the Pleistocene period.
Studies point out, for example, the existence of human fossils from about 11
thousand up to 48 thousand years at sites in two Brazilian states. Knives, axes
and remnants of fire found in those places indicate the existence of
communities that lived collectively, hunted and used the fire as a form of
protection and as a mean to cook food (Souza, 2015). However, the analysis of
human skeletons from that time showed that their physical characteristics are
not similar to those of current indigenous people, who are more like
Mongolian populations. This finding suggests that there had been more than a
wave of settlement in lands that are part of Brazil (Melatti, 2007).
There are several hypotheses about the possible arrival of man at the
American continent. One of them suggests that Asiatic peoples crossed the
Bering Strait and occupied initially North America. Another one, the
Australian hypothesis, argues that populations coming from the South Pole
went to Patagonia, occupying the lands of the South of America. On the other
hand, the Malayo-Polynesian hypothesis claims that populations came from
the Polynesian islands, taking advantage of the Peruvian maritime stream to
navigate to the continent. The Asian and the Australian hypotheses are the
most widely accepted by scholars (Ricci and Scaldaferri, 2014).
The growing presence of the Portuguese conquerors in lands of Brazil
since the beginning of the 16th century resulted in the extermination of huge
numbers of indigenous peoples who had lived in this country till then. The
Portuguese, in their contacts with the Indians, soon realized the enormous
contrasts between the worldview, values and principles prevalent in their home
country and those typical of the indigenous peoples of the new lands.
Characteristics of civilization - religion (Faith), justice (Law) and sovereignty
(King) - were non-existent among the indigenous peoples, according to the
European conquerors’ perspectives. This fact was registered by a Portuguese
chronicler - Pero de Magalhães Gandavo - who wrote in 1576: “the Indians
have no Faith, no Law, no King, and thus they live disorderly” (Fausto, 2001,
p. 38). These elements, besides the religious and cultural manifestations of the
natives, were used to justify the conquerors’ colonial project imposed through
disease, slavery, war and religious ideology. Diseases, such as influenza and
measles, to which the Indians had no resistance, led to the death of entire

indigenous societies, similarly to the black plague in European countries

during the Middle Age. In addition to the diseases, slavery imposed on the
Indians and the invasion of their lands by the settlers in search of natural
resources, such as wood, rubber and minerals, continued the decline of
indigenous peoples over the following centuries. Other more recent threats to
the survival of indigenous peoples include the expansion of the electric power
generation and transmission and the opening of roads in indigenous lands, as
pointed out by Koifman (2001) and Loebens and Carvalho (2005).
Koifman (2001) investigated the impact of the construction of
hydroelectric dams on indigenous communities, most of them located in the
northern region of Brazil, signaling as direct or indirect consequences:
The relocation of communities to other regions, often accompanied

by disruptions in their lifestyles; the flooding of large territorial parcels
including areas considered sacred, such as the traditional burial sites; the
invasion of indigenous lands facilitated indirectly by the expansion of the
power sector facilities; the decrease in game for hunting and the reduction
in cultivable areas; and the proliferation of vectors, including arthropods
and mollusks, leading to an increase in the incidence of malaria and other
infectious diseases. (p. 414)
According to Koifman (2001), similar reports have been made by

representatives of various indigenous communities of other regions of
the country. The author also calls attention to the socio-economic and
epidemiological impact on the indigenous peoples of the Amazon region, with
the construction of the more than 100 hydroelectric dams that have been
planned for the region.
Loebens and Carvalho (2005) also underline that massacres against
indigenous peoples are back again with the policies for the Amazon region
development and integration, which led to the construction of highways,
affecting severely numerous indigenous peoples, such as the Waimiri-Atroari,
Yanomami, Arara, Parakanã, among many others. The authors alert that even
extermination expeditions were used during this work with the connivance of
the public authorities.
Over several decades of the last century and even more recently, another
factor that led and has led to the extermination and disruption of indigenous
peoples from the Amazon region was the open fight by rubber tappers
responsible for rubber extraction with the Indians of the Amazon. R. Soletti*
(personal communication, February 29, de fevereiro de 2016), who has been in

contact with indigenous peoples since 1995 and lived together during eight
years with the Enawenê-Nawê, ethnicity of the Arawakan, in the Amazon
region, in an interview with the second author of this chapter, presented a
report of what happened with the Myky, when this people were harassed by
the rubber tappers:
The Myky were victims of a so violent contact with the rubber

tappers that they were obliged to be nomads again. They passed to
manufacture small appliances because if they needed to run away they
could not carry heavy things. The tradition of clay objects was abandoned
for being heavy, difficult to transport. They had to adapt their way of
building their lodge, which became more simple and practical, always
thinking about having to leave the territory. For them, this contact was
very cruel.
It is difficult to specify the current number of indigenous peoples in

Brazil, because there are those who are isolated, concentrated in the states of
the Amazon region, resisting contact; there are others in intermittent contact
and still others who maintain contact with Brazilian society, but residing in
hard-to-reach villages, besides those who live in cities, but not always
identifying themselves as Indians (Melatti, 2007). The estimates vary, but
according to data from the National Indian Foundation, there were 329,000
indigenous people at the end of the last century (Grupioni, 2001), the majority
in the Brazilian Amazon. In complement, Loebens and Carvalho (2005) report
that 180 indigenous peoples, with a population of approximately 208,000
individuals inhabited that Brazilian region at the beginning of the present
century. This is a limited number compared to the indigenous population that
lived in Brazil when the Portuguese settlers arrived to this country. More
recently, the 2010 population census (IBGE, 2010) recorded a number far
superior to the one registered previously - 817,963 - corresponding to .47% of
the Brazilian population. It is noteworthy that until the middle of the seventies
of the last century, the belief prevailed that the disappearance of the Brazilian
indigenous peoples would be inevitable. But in the eighties, there was a
reversal of the demographic curve of many indigenous peoples, which started
increasing again. Still, seven ethnicities have populations between 5 and
40 individuals. (http://pib.socioambiental.org/pt/c/0/1/2/populacao-indigena-
in-Brazil).

BRAZILIAN INDIGENOUS PEOPLES: DIVERSITY

AND COMMON ELEMENTS
The Brazilian indigenous peoples share many characteristics. However,

they also present an immense diversity among them in respect to languages,
traditions, myths and beliefs, artistic expressions, worldviews and social
organization. Grupioni (2001, p. 18) underlines that “each indigenous society
has its own identity; each society thinks and sees itself as a homogeneous and
coherent whole and seeks to maintain its specificities, despite the destructive
effects of contact.”
This diversity will be detailed below. Reports of professionals who lived
together with Indians will also be presented, illustrating some of the topics
addressed.
Indigenous Languages
Many languages were and continue being spoken by indigenous peoples.

Melatti (2007), a Brazilian anthropologist who examined the issue, reports that
150 languages have already been identified, and classified in nine linguistic
families. Eight of these families were included in the linguistic trunks tupi and
macro-jê. The author presents an interesting description of the role of the
languages in indigenous social relations, highlighting:
The language carajá has a few phonemes which are pronounced

differently depending on the sex of the speaker ... There are societies in
which individuals connected by a certain relationship cannot talk: the
craôs ritual-friends, the son-in-law and father-in-law cadiuéus ... In
Northwest Amazonia, the spouses must be sought in groups which do not
speak the same language; and the woman, when married, move to the
husband’s local group. So, several languages are spoken in each local
group: the men’s language and the languages of women from different
groups who got married with the men of that group (p. 71)
Rituals, Myths and Practices
The ritual life, which manifests itself in various occasions, is one of the
highest values of the indigenous societies. There are rituals associated with

hunting, harvesting, wedding, the passage of the young individual to the adult
life, the birth of a child, the transformation of a young person into a warrior,
the celebration of the seasons of rain and drought, the burial of the dead, the
choice of names, the identification among the young people of those with the
potential to turn into a shaman, tribal rituals to appeal to ancestors in favor of a
cause or used for the cure of diseases, among many others. How the rituals are
performed varies among the numerous indigenous societies. The ritual of the
birth of a child among the Enawenê-Nawê was described by R. Soletti
(personal communication, February 29, 2016) in his interview with the second
author of this chapter:
During one night, an intense movement happened. The women of the

tribe were getting up to assist a parturient and one of them knocked on
my hammock and woke me up. The last one who passed invited me to
watch and that's why I went. What I watched was impressive: a woman
giving birth crouched, squatting on a hole that had been opened with a
sickle. A woman, quite sleepy, supported the sickle while the parturient
clung to it firmly. After birth, the baby was put to the side. Nobody
touches the baby, because it is necessary to make the delivery of the
placenta. When it happens, the placenta is buried in the hole already dug.
The cord is cut by a bamboo. The woman then puts her son on the
shoulder and he is plunged in a herbal bath. The woman's body is also
fully washed and some of this liquid is ingested by the new mother,
because it helps the uterus to contract faster. The woman puts on a red
skirt, with one part that helps stop the postpartum bleeding...
R. Soletti (personal communication, February 29, 2016) also described

how the marriage partner is chosen, as well as the assignment of a name to a
child in the ethnicity of the Enawenê-Nawê:
The wedding in that ethnicity is characterized as clanic. This means

that, when a boy is born, the mother of a girl goes to the home of the
newborn. There is a whole ritual. It is necessary to go to the inner part of
the lodge with an offering. The weddings are thus being combined. It is
common for the girl to be five years older than the boy. In other cases,
what happens is that, at the occasion of the birth, no one makes any
offering. The child grows, grows and then, at four, for example, a girl is
born. At this occasion, an offering is made and the marriage is combined.

Among the Enawenê-Nawê, it is always the man who transmits the clan
for the children. The boy always receives the father’s name. The mother may
also call his/her child by the name of her clan, but it is the father’s name that is
the social register. And they have a “shelf of names.” At birth, the boy
receives the father’s name. When the child becomes father, Enê is added. For
example, let's assume the child was called “Joaquim” at birth. Later, he would
be Joaquim-Enê. When the adult becomes grandfather, “Atokewe” is added.
This is how they create the names and designations.
On the other hand, M. A. G. Silva (personal communication, March 4,
2016), who stayed from 2005 to 2011 with the Indians from the Upper Xingu,
at the Amazon region, described how is the marriage among these indigenous
people, in an interview with the second author of this chapter:
The agreement is made when the mother promises her daughter in

marriage to the father of a boy. The boy’s name will be changed as he
grows towards puberty. When the girl menstruates for the first time, her
preparation for life is started. She stays away from contact with the tribe
for a year or two.
Her fringe grows to hide her face, she only goes out at night and is
fed with much beiju (a special food prepared with manioc) and fish to
“acquire body,” to become strong. Each arm and each leg is tied tightly
actually generating edema that outlines the body, for example, to make
the calves very prominent. The mother stays with her in the lodge,
teaching her everything she needs to know about life, about the routines
of the tribe. She only goes out of the lodge to bathe in the river at night,
fully wrapped. This is necessary for her not to be seen by mamaé (evil
spirit) and not be hurt by this spirit. So, she remains for the next year.
The boy also experiences the seclusion at puberty. As soon as the
boy’s body hair starts to grow and the voice starts deepen, he is also
confined. His arms are tied to create muscles and his skin is completely
scratched with a kind of fish, known as “Teeth of Dog.” Then, many and
many herbs are used to anoint and prepare his body. Male fitness is a
masculine value. The men need to be strong, to be muscular. In the case
of women, however, the care with village tasks is valued.
After the period of seclusion, weddings take place during the
Kuarup. This is a celebration that usually occurs due to a loss, because it
is a tribute, a year after the death of an Indian ... The boy leaves his
father's lodge and moves to live with his mother-in-law. It is his duty to
supply the sustenance for his mother-in-law and his wife. His hammock
is mounted above his wife’s hammock... He cohabits together with his

mother-in-law, but he does not have contact directly with her. Everything
he needs to say to her, he transmits to his wife. He does not refer to
names, only titles. It's just father-in-law/mother-in-law, brother-in-
law/sister-in-law.
A central figure in all indigenous groups is the shaman, responsible for

healing rituals, with special powers to evoke the gods and ancestors to help in
healing, although he has also other functions, such as to protect communities
from evil spirits, find stolen goods or lost people in the forests, in addition to
identify wizards. There are numerous descriptions of rituals related to the
process of selecting the one or those among the inhabitants of the tribe who
will become shamans. Similarly, there are several descriptions of healing
rituals performed by shamans through the control of the spirits that cause
diseases (Albuquerque and Faro, 2012; Laraia, 2005; Melatti, 2007, Weigel
and Lira, 2011).
Silva (March 4, 2016), in his interview with the second author of this
chapter, described the process of becoming a shaman in tribes of High Xingu
and other aspects related to his activity:
It all begins with dreams. The boy begins to dream/feel the spirit’s
presence, feeling very ill. Then the shaman realizes that the boy may
become a shaman. At this occasion, a long period of four to five years of
reclusion begins, during which the native is being prepared. No
intercourse is permitted. After this period, the new shaman begins to act.
The more he can heal, the more he recognizes the presence of spirits, the
more he begins to be requested. A tribe can have various shamans. And
the shaman of an ethnic group can attend another ethnic group. To
conduct the ritual of shamanism, namely, the cure, which can be with the
imposition of the hands and smoke, songs or use of herbs, it is necessary
to pay, not for the shaman’s “service,” but for the spirits. The payment is
with clay dishes, hammock, shell necklaces, depending on the severity of
the problem. This necklace, for example, is very expensive and useful, i.
e., when the death curse is removed.
On the other hand, among the Assurinis Indians, the ritual to identify,
among the young Indians, those with the potential to become a shaman is
called Opetino, which literally means to eat fire: among songs and dances, the
candidates smoke a big tobacco cigar, swallowing the smoke. Those who do
not feel well, that is, experience nausea, are rejected. Those who faint are the
chosen ones (Laraia, 2005).

In respect to the healing ritual by the shaman, Wagley and Galvão (quoted
by Laraia, 2005), present the following report:
The shamans prefer to heal at night. One of the reasons is to

guarantee an audience, which would be difficult during the day, when
many people are at the plantations. The shaman starts healing singing the
songs of that supernatural which an inquiry leads him to consider as
likely to be the source of the illness. He accompanies himself, keeping the
rhythm of the song with a strong beat shaking the maraca (a musical
instrument). The shaman dances around the patient. In general, the family
and some of the bystanders follow him. The wife or a helper prepares
cigarettes made of tobacco leaves rolled up in a tawari leaf. A helper
takes the maraca and the shaman worries only with the healing itself from
that moment on. He sucks the cigarette repeatedly, blowing smoke in his
hands or in the patient's body. The shaman retires to one side and sucks
the cigarette until he becomes dizzy. Then, he moves backwards
suddenly, raising his hands to his chest, which indicates that he has
received the spirit in his body. It is during the trance, while he is
possessed by the spirit, that the shaman heals. (p. 8-9)
There are rituals that involve pain and poison, some where children may
be present and others in which only men participate. Junqueira (2004), who
investigated the Kamayurá society, which is located in the upper Xingu River,
Amazon region, reports rituals observed among wizards, who are individuals
seen in this society as mysterious figures, to whom the misfortunes and
unexplained deaths are ascribed. Wizards’ action contrasts with that of the
shaman, the spiritual leader of the tribe, conductor of the healing rituals, and
connoisseur of teas and herbals that eradicate diseases. The shaman also plays
other roles that include identifying wizards, always feared by all people in the
tribe. The wizard, according to the description given by Junqueira (2004),
intentionally receives bites of a species of poisonous ant, scratches himself and
rubs pepper in the wounds, and places a toxic caterpillar under his arms to
cause burns. Such rituals are taken by the wizard as sources of power and
strength, enabling him to eliminate opponents.
Rituals involving children are described by Silva, Macedo and Nunes
(2008). Silva (2008), who investigated the Xikrin society, calls attention to the
intense ritual life of that society and the active participation of children in
many rituals. Their presence is not allowed only in those regarded as
dangerous, such as those accomplished when preparing a dead for burial.

Silva (2013) highlights that the rites express and renew the essential
values of the indigenous societies, reinforce the group identity, as well as
renew the individuals’ conception of themselves, of the society and of the
universe. Each ritualistic act represents a fragment of the indigenous
cosmological vision, strengthening the links between the members of each
society and nature.
In addition to the rituals, numerous myths about various themes prevail
among the Brazilian indigenous peoples, as, for example, about the universe,
who created it and what the process of origin of the world was; how the
cultivation of the land and the production of instruments were learned by men;
and who established the social norms of the society to which they belong.
They are part of the dominant belief systems of the indigenous societies and
contribute to strengthening values and characteristics exalted by the
indigenous peoples, besides facilitating the assimilation and strengthening of
their culture. There are societies in which they chant myths during some
rituals, such as, for example, the Marubo Indians, who live in the Amazon
region (Melatti and Melatti, 1982).
In every society, there are also practices to stimulate and correct their
members from the beginning of their life. The Marubo Indians, for example,
make use of the urtica, a shrub with thin and flexible spines that produce burn,
with the purpose of removing the child’s laziness. This practice is used from
the time the child is three years old. These indigenous people believe that the
child receives the qualities of dedication to work from those who apply the
procedure. The urtica is also used in the harvest of corn ritual, applied to the
arms of those who perform this task, with the same purpose, i.e., to remove
laziness (Melatti and Melatti, 1982).
Artistic Expressions
Artistic expressions of various natures are common among Brazilian

indigenous peoples, similarly to what is observed in all human societies. One
of them is the plumage art, feather ornaments used on special occasions, such
as in rituals. Some societies dominate techniques of changing the feathers’
colors, using paints extracted from vegetables or diets offered to birds.
Different styles of masks are also found in numerous societies, which are
made with various materials (bark, wood, straw or ceramic). There are masks
that represent the spirit of the enemy, and others mythological beings or
animals, that are part of the clothing required in certain ceremonies and rituals

(Melatti, 2007). Some are used only by men and others by women, and there
are even reports of rituals, like in the Xikrin society, where women dance with
two masks made of straw (Silva, 2008).
Other artistic expressions refer to ceramic objects, in the form of pots and
vases; wood, such as benches carved in the shape of animals; and body
paintings, which are often used to indicate social groups and/or specific for
special occasions. The modalities of artistic expressions, along with the
material used in the confection of ornaments and objects of daily use, vary
from society to society. One cannot also fail to mention the chanting and
dancing, accompanied or not by the sound of musical instruments, such as the
rattle, many of them an essential part of rituals (Melatti, 2007).
Common Features
Lack of centralized political institutions and hereditary chiefs are common

characteristics among the Brazilian indigenous peoples (Fausto, 2001).
Indigenous groups are not class societies, there being a minimum of social
differences. Solidarity and sharing, deference to freedom, and respect and
intimacy with other entities of nature - plants, stones, animals, sky and Earth -
are the rule. The exploitation of natural resources is carried out assuring their
renewal. The indigenous peoples have deep connections with their lands and
nature. Entertainment, religion and work are not separate spheres of human
activity, and it is not possible to separate clearly the sacred from the profane
(Zarur, 2000). Their world view is holistic, as well as their vision of the human
being: body, psyche and spirit must be in harmony with the Cosmos, a
condition for good health (Alencar, Braga, Prado, and Chagas-Ferreira, 2016).
Autonomy is another feature among different indigenous groups, as
pointed out by Silva (personal communication, March 4, 2016):
Autonomy is something much valued by the indigenous and,

therefore, its loss with the process of acculturation is something very bad.
The child has autonomy since the first year of age. While he/she crawls,
the child is looked after, watched over, but he/she is never infantile. The
child is treated as an equal. And from one year of age, when he/she starts
moving, the child starts following the mother everywhere, on the
plantation, on the edge of the river. That is why they learn to swim so
early and so well. Because they are present in all their mothers do.

BRAZILIAN INDIGEOUS PEOPLES IN CONTACT WITH

THE DOMINANT SOCIETY: CHALLENGES,
CONQUESTS AND CONTRIBUTIONS
When the challenges faced by Brazilian indigenous peoples nowadays are
examined, the relationship of the tribes with the technologies appears fairly
often. In fact, the ensemble of economic, political, social and communicational
changes, boosted by the turn of the 20th to the 21st century, made the
word technology increasingly more present in human mediations, and this
was not different with the Brazilian indigenous. Sodré (2002) points out
that the new technologies coincide with the accelerated expansion of capital.
This reality, coupled with the union of microelectronics, nanotechnology and
communication networks, made mobile devices increasingly accessible,
permitting the circulation of the information in stream under a variety of
forms, such as sounds, images and digits. Thus, society is inserted in a context
of informational limits more tenuous, marked by interactivity, connectivity
and mediation of human relationships by electronic devices. Schmidt and
Cohen (2013) predict that most of the world's population (about eight billion
people) will be online by 2025. They also inform that the number of people
who make use of the internet increased from 350 million to two billion users in
the first decade of the 21st century. Furthermore, the amount of cell phones
increased from 750 million to more than six billion users at that same period.
The increasing use of technology is also experienced by Brazilian indigenous
peoples.
This reality can be proven in the Kumenê village, one of the most isolated
tribes in the state of Amapá, in the northern region of Brazil. The physical
access to this community requires the crossing by three rivers, the Oiapoque,
the Uacá and the Urukauá, during 20 hours. This time can be even higher
depending on the tide’s influence. When there is flooding, the water level
makes the passage of vessels impossible in some points. If the natives are
almost totally isolated in the middle of the jungle, the same is not true from the
technological point of view. The village has a power generator that runs daily
from 7 p.m. to 11 p.m. Solar panels also capture energy during the day. The
result has been a change of habits, such as daily use of television to watch soap
operas. In addition to the television, mobile phones and laptops are also much
used, even if there is no mobile phone reception and internet. In the absence of
connectivity generated by data circulation, the natives make creative uses of
the appliances: the young people enjoy making videos, recording the daily life

of family and friends. They register hunting and fishing, habits and customs.
Another common practice is the use of the cell phone as entertainment. Signs
of the cultural mix are noticeable in talks of the indigenous Jafre Loio, 34
years of age, to the portal site G1. He says he uses his cell phone for
entertainment. The device allows him to listen to Gospel music in the mother
tongue of his tribe, which is the Palikur dialect. In school, although the dialect
is preserved, the teacher makes use of technology to show images and figures
that contribute to the indigenous’ literacy – even in their mother tongue. The
teacher reports that she misses the benefits that connectivity, enabled by
internet, could bring to school (Santiago, 2014).
In the tribe Tupinambá de Olivença, the technology was incorporated as a
visibility tool. According to reports of the Indians, the technology emerges as a
way of revealing things to the country (referring to Brazil) that are not
presented by traditional media. Data taken from the site tupivivo.org show that
In the Tupinambá Olivença tribe, technology was widely

incorporated as a fighting tool in their struggle against farmers: cameras
and cellphones are used to record; email and cellphone to inform relatives
about the conquests. They set up blogs and publish on social networks,
among others. They use information and communication technologies to
refute the attacks of the media linked to the farmers’ interests and also to
seek support for their struggle. (http://www.tupivivo.org/7/)
To the Tupinambá, a great achievement is the INDIAN ONLINE network,

a site of information about indigenous communities which is run by volunteers
from various indigenous ethnicities. This network, already established, has the
support of a non-governmental organization, of the Brazilian Ministry of
Culture and of other entities. Another prominent program which relates
technology and Brazilian indigenous peoples is known as Digital Lodge. It is
built with about 30 computer stations and various computer courses. Its goal is
to convey technology to indigenous peoples of several nations. The technology
allows the Indians to stay connected to the rest of the world, to find members
of the village who disappeared and to report their customs.
When interviewed about the challenges faced by Brazilians indigenous
peoples today, Soletti (personal communication, February 29, 2016) and Silva
(personal communication, March 4, 2016) gave emphasis to different aspects.
Soletti highlighted the need to preserve the indigenous autonomy:

The question of indigenous autonomy is that it needs to be

maintained but it is not always assured. Previously, it was necessary 10
people paddling uninterrupted to cross a river. That is, a long time to go,
and still more time to go back. Today with a stern motor, the river is
crossed in 2 hours and this is a wonderful gain indeed. But the Indians do
not know how to fix a broken engine, for instance. I believe that this is an
issue that needs the intervention of the indigenous organizations. These
organizations should give support so that the indigenous people can use
well the technologies that are coming to them. I cannot agree that the
solution is to provide social welfare benefits... This is to treat the Indians
as people in extreme poverty, who need to receive help from the
government.
Silva (personal communication, March 4, 2016) also sees with restriction

the social benefits given by the Government to the indigenous peoples:
I see problems when the Government gives social benefits: this

action does not stimulate the indigenous to fish, to hunt and to have
his/her daily routine. More sedentary, he goes to the nearest cities to buy
food that is not typical among the indigenous, such as alcoholic beverages
and soft drinks, processed foods. The result, as I could witness, is an
increase of cases of hypertension and diabetes. In the past, when I was in
the villages, there were few cases of hypertensive patients. I knew by
name who they were. Diabetics, for example, I had two. Today, I see that
the incidence of these diseases increased greatly.
Silva considers the question of identity a big challenge, especially among

the younger Indians: “I don't know who I am, I'm an Indian, but I don't want to
be Indian. I want to be white, live in the city, take advantage of the
technology.” Silva reminds also that the arrival of the satellite in the tribes,
although with advantages, has contributed to eliminate tribal values.
According to him, the young people do not want to learn the tribal chants,
which contributes to a break in culture.
Technology, however, goes far beyond the advancement of
microelectronics. Pisani (2009) reminds us that technology is understood as
the use of scientific knowledge that specifies ways of doing things so they can
be reproduced. This “technological knowledge,” therefore, is very connected
to cultural forms as each person settles and uses available resources. In
this sense, it is necessary to evaluate the counterpoint: how indigenous
technologies are incorporated into the culture of the “whites.” The Brazilian

indigenous technologies were very helpful not only in the period of

colonization, but in the present days as well. The holistic wisdom, which is
established with the integration of all parts, is the basis of indigenous
technologies, always linked to nature. Western society has experienced a
vertiginous progress, often unlinked to an integrative dimension that takes into
consideration the environment. Consequently, an excessive production of
garbage and an imminent scarcity of non-renewable resources are observed.
Athayde (cited by Dias, 2013) reminds us that
Technological inventions of the current era took man to the Moon

and decreased the distance between human societies through the transport
systems and internet. They made us more resistant to diseases, but they
left the planet vulnerable to climate changes, due to the uncontrolled use
of natural resources and population growth.
In this sense, the indigenous technologies have a lot to add to the already
known systems. For the Indians, the gap between the raw material and the
product is small. They dominate the process altogether, with functions
distributed according to age and role in the community in which they are
inserted. “So, a young Indian learns from her mother, grandmother and aunts
to plant and harvest cotton, take care of the seeds, spin and weave hammocks
for her family. She is at once a scientist, engineer and artist.” (Athayde cited
by Dias, 2013). This thought is reinforced by Robbins (1995), when she
describes the holistic process involving the primitive peoples. In this
perspective, there is no separation between shaman, healer, artist. All
processes in the villages are holistic, with outstanding interaction between the
parts, and the sacred permeating all spheres.
This manner of working with technology has taught much Brazilian
science, notably in relation to agriculture. Lopes (2008) reports that, although
indigenous Xingu tribes have not studied genetic engineering, their knowledge
about crops of peanuts and manioc is equivalent to an experiment of
paramount importance. In respecting the time of harvest, which may be up to
three years, the indigenous people end up visualizing the crossing of species
that a common farmer, with commercial interests, would not be able to see.
Also Melatti (2007) calls attention to the value of indigenous technical
knowledge, which has attracted the attention of specialists from different
fields, such as biology, chemistry, pharmacy, agriculture and medicine. Plants
used by Indians have been, for example, tested in the preparation of medicines.
The Indians’ knowledge of poisons used in fishing and hunting, their

knowledge about vegetables with stimulant or hallucinogenic properties,

beyond those about vegetables with contraceptive properties, among others of
the indigenous tribes domain, are described by the author, who highlights that
“along with a belief in occult forces, the Indians also have a scientific attitude
in face of nature” (p. 217).
It is well known that many elements from indigenous peoples have been
incorporated into the Brazilian culture besides those previously pointed out.
The habit of sleeping in hammocks is common in some villages of the north
and northeastern part of the country. Caiporismo (the belief in sorcery and
magical actions) and openness to animism have made the Brazilian people
opened to new forms of religious expressions and spiritual practices (Freyre,
2003). Rituals or the use of objects to protect oneself from evil spirits are still
observed in some regions.
BRAZILIAN INDIGENOUS RIGHTS:

CONQUESTS, THREATS AND STRUGGLES
Legal measures concerning the indigenous peoples have been promulgated
since the beginning of the Portuguese colonization in the 16th century, to meet
the interests of those who wanted to enslave the indigenous people, to attend
the missionaries’ purpose of converting the Indians to Christianity by forcing
them to adopt the civilized customs, or in favor of the Indians, recognizing
them as free (Melatti, 2007). In a more recent period, a breakthrough in terms
of indigenous policy was the creation of the Indian Protection Service, in
1910. This Service proposed to guarantee the indigenous peoples’ right to live
according to their traditions, ensuring them the possession of their lands, their
protection in their territories, in addition to other rights. However, as Melatti
(2007) underlines, this Service did not have the success that one would expect:
“the difficulties in tackling the diseases, in stopping the land invasions, in
fighting the exploitation of the indigenous work continued, once the Indian
Protection Service did not have the necessary financial resources, competent
personnel and judicial support to assist the Indians” (p. 254). This Service was
discontinued in 1967, when the National Indian Foundation was created. In
turn, this Foundation has had difficulties in enforcing effective measures to
deal with the assaults against Indians, continuously carried out by powerful
economic groups that aim to appropriate the wealth available in the indigenous
lands, including minerals and timber, or make use of the lands for farming.

The Foundation’s actions have been criticized by indigenous leaders, like

Luciano (2012), who considers it “retrograde and bankrupt” (p. 145).
According to this author, it is urgent that this Foundation passes through the
necessary changes to accompany the changes that have occurred in the
Brazilian indigenous scenario.
Of fundamental importance for the indigenous cause was the Brazilian
Federal Constitution promulgated in 1988 and valid until the present days. The
Constitution includes articles recognizing the historical rights of indigenous
peoples with regard to the permanent possession of their lands and the
indigenous use of the natural resources there present. The Constitution
established yet the limit of five years for the completion of the demarcation of
these lands, which in fact occurred only partially. In this regard, data presented
by Loebens and Carvalho (2005) show that less than half of indigenous lands
had completed the administrative procedure for demarcation by the middle
of the last decade. Recent data indicate that more than 200 requests for
demarcation of lands are on hold for registration (www.theguardian.
com/world/2015/april/23/brazilis-indigenous-groups-battle-land-law-change).
There have been numerous attempts from anti-indigenous sectors, including
even state governments, to obstruct the demarcation of land especially in the
Amazon region and even to contest judicially demarcations already finalized
(Loebens and Carvalho, 2005).
A new threat nowadays is an amendment to Brazil’s Constitution – PEC
2015 - that is being proposed, altering the rules about the demarcation of the
indigenous lands from the Executive to the Legislative, by decree – that is,
from the Indian National Foundation, the Ministry of Justice and the country’s
president, to the Congress. Due to the fact that the Congress includes
numerous members representing agro-business, mining and energy industries,
who are contrary to indigenous interests, that Proposal of Constitution
Amendment, once promulgated, will be one more obstacle to the maintenance
of the indigenous territories.
What actually has occurred are constant threats to the life of the natives, as
Loebens and Carvalho (2005) underline, referring more emphatically to the
indigenous peoples of the Amazon region:
Indigenous lands in legal Amazon, as in the rest of the country,

are extremely vulnerable, constantly invaded by loggers, miners,
fishmongers, rice production, farmers, squatters, bio-pirates and other
adventurers in search of easy profits. In the South of Pará, in the Kayapo
indigenous area, for example, there is smuggling of mahogany. In

Rondônia, indigenous lands are still being destroyed by illegal

exploitation of wood and clandestine prospecting. In the Raposa Serra do
Sol indigenous land, located in Roraima state, farmers practice
monoculture of rice using pesticides that poison the rivers and soils and
cause the death of birds. (p. 246-247)
Initially, to face the Portuguese colonizers and more recently to defend

themselves from the society sectors interested in taking advantage of the
indigenous lands’ wealth, indigenous peoples have used several strategies.
Until the 19th century, direct confrontation, open wars, tacit acceptance of
domination, when this was the most advantageous alternative, or alliances with
marginalized sectors of society, as occurred in the Amazon during a social
uprising in the state of Pará, in the first half of the 19th century, have been
frequent (Loebens and Carvalho, 2005).
In recent decades, an articulation between indigenous peoples started to
occur. These peoples began to organize themselves in the form of associations
to defend their interests and rights. A survey published by Grupioni, in 1999,
pointed out 290 indigenous associations, most of them in the Amazon region
(Melatti, 2007), some of them focusing on all indigenous issues and others
with more specific interests, such as the associations of indigenous teachers.
Various associations have promoted demonstrations to draw public attention to
their rights and struggles. Some years ago, for example, a protest against plans
from the Brazilian government to weaken the indigenous rights was organized
with the participation of hundreds of Indians. On another occasion, a great
poster with the words “Reduced yes, conquered never” was carried on a march
by Indians from the Amazon to call attention to their struggle for their rights
(Loebens and Carvalho, 2005; www.survivalinternational.org.tribes/brazilian).
Many protests anti-PEC 215 have occurred in various cities recently. One of
these events was in Brasilia, the country's capital, in December 2015: a group
of delegates from several indigenous ethnic groups went up on the roof of the
National Congress to protest against the constitutional amendment PEC 215.
The indigenous leaders requested sensitivity to the indigenous question from
the parliament members and danced sacred rituals, calling on their ancestors
for PEC 215 not to be approved (Correio Braziliense, 2015).

CONCLUSION
Several conquests in respect to their rights were achieved by Brazilian
indigenous peoples in recent years. One of them was the introduction of quotas
for the admission of indigenous people in higher education in some public
universities. Another one is the occupation of public and political functions in
the public administration, which has occurred in several Brazilian cities.
Despite these conquests, misleading ideas, intolerance and even prejudice in
relation to the indigenous people prevail in Brazil (Grupioni, 2001; Laraia,
2008; Silva, personal communication, March 4, 2016).
The challenges faced by the indigenous peoples today are numerous.
Several of them were pointed up by Luciano (2012), an indigenous leader
from the Amazon region who has been involved with the indigenous cause for
more than twenty years. He calls attention to the following challenges, among
others:
a) To resist the historical seduction of the white man’s world ... and their
various instruments of economic, cultural and political power;
b) to promote the socio-political articulation of the indigenous peoples at
the national level, a fundamental requirement for the defense of their
rights;
c) to reverse the process of the indigenous peoples’ dependence on the
Government or on the white man to solve their problems, even those
simpler, whose solution could be found by the community itself;
d) to maintain and guarantee the indigenous rights already acquired, in
addition to struggle to attain other rights that still need to be achieved
to consolidate the ethnic perspective of the future, burying once for all
the threat of extinction. (p. 146-148)
It is imperative that the indigenous question receives a greater attention on

the part of the Brazilian authorities. The respect to the indigenous peoples’
culture and the protection of their lands are demanding a greater effort on the
part of the competent authorities in Brazil. This is a sine-qua-non condition for
these peoples to enjoy their rights as Brazilian citizens, which have often been
denied them.

REFERENCES
Alencar, E. M. L. S., Braga, N., Prado, R. M. and Chagas-Ferreira, J. F.
(2016). Spirituality and creativity of indigenous societies in Brazil and
their legacy to Brazilian culture and creative giftedness. Gifted Education
International. doi: 10.1177/0261429415602581.
Albuquerque, M. B. B, and Faro, M. C. S. (2012). Saberes de cura: um estudo
sobre pajelança cabocla e mulheres pajés da Amazônia [Knowledge of
cure: A study about pajelança cabocla and shaman women of Amazonia].
Revista Brasileira de História das Religiões, 5 (13), 57-72.
Amoroso, M. R. (1998). Mudança de hábito: Catequese e educação para índios
nos aldeamentos capuchinhos [Catechesis and education to indigenous
people in the Capuchins’ villages]. Revista Brasileira de Ciências Sociais,
13(37), 101-114. doi:10.1590/S0102-69091998000200006.
Baraldi, C., Cogo, D., Magalhães, G. M., Illes, P., Marinucci, R. and
Waldman, T. C. (2011). Brasil: Informe sobre a legislação migratória
e a realidade dos imigrantes [Brazil: Report about migratory
legislation and the immigrants’ reality]. In. Retrieved from http://
www.cdhic.org.br/?p=203.
Correio Braziliense (2015, December 17). Índios protestam e pedem saída de
Cunha [Indigenous people protest and request Cunha’s departure].
Correio Braziliense, p. 9.
Dias, J. A. (2013, June 9). Tecnologia Indígena [Indigenous technology].
Retrieved from http://profjabiorritmo.blogspot.com.br/2013/06/ tecnologia
-indigena.html.
Fausto, C. (2001). Formas sociais e políticas, ontem e hoje [Social and politics
forms, yesterday and today]. In MEC: Índios do Brasil [MEC: Brazilian
indians] (pp. 37-48). Brasília: MEC. Secretaria de Educação a Distância.
Freyre, G. (2003). O indígena na formação da família brasileira. In G. Freyre
(Ed.), Casa grande e senzala: Formação da família brasileira sob o
regime da economia patriarcal [Brazilian family formation under the
system of patriarchal economy] (48th ed., pp. 156-263). Rio de Janeiro:
Global.
Grupioni, L. D. B. (2001). Índios: passado, presente e futuro. In MEC: Índios
do Brasil [Brazilian indians]. (pp. 7-28). Brasília: MEC. Secretaria de
Educação a Distância.
IBGE (2010). Censo 2010 [Census 2010]. Brasilia: Instituto Brasileiro
de Geografia e Estatística. Retrieved from www.ibge.gov.br/home/
estatistica/popuoacao/censo2010/.

Junqueira, C. (2004). Pajés e feiticeiros [Shamans and wizards]. Estudos

Avançados, 18, 289-302.
Koifman, S. (2001). Geração e transmissão da energia elétrica: impacto sobre
os povos indígenas no Brasil [Electric power generation and transmission:
The impact on indigenous peoples in Brasil]. Cadernos de Saúde Pública,
4, 413-423.
Laraia, R. B. (2005). As religiões indígenas: O caso tupi-guarani [Indigenous
religions: The tupi-guarani case]. Revista USP, 67, 6-13.
Laraia, R. B. (2008). Índios do Brasil revisitados [Brazilian indigenous people
revisited]. Revista USP, 79, 216-220.
Loebens, E. H. and Carvalho, P. D. (2005). Amazônia indígena: conquistas e
desafios [Indigenous Amazon: Conquests and challenges]. Estudos
Avançados, 19, 237-254.
Lopes, R. J. (2008, September 18). Alta tecnologia indígena ajuda a manter
diversidade agrícola [High indigenous technology helps the maintenance
of agricultural diversity]. Retrieved from http://g1.globo.com/Noticias/
Ciencia/0,,MUL764154-5603,00-alta+tecnologia+indigena+ajuda+a+
manter+diversidade+agricola.html.
Luciano, G. J. S. (2012). Uma aventura entre a cruz e a espada que mudou a
história: 20 anos de luta indígena no Rio Negro [An adventure between
the cross and the sword that changed History: 20 years of indigenous
struggle in the Negro River. In S. G. Baines, C. T. Silva, D. I. R.
Fleischer, and R. P. Faleiro (Eds.), Variações interétnicas. Etnicidade,
conflito e transformações [Inter-ethnic variations. Ethnicity, conflict and
transformations] (pp. 129-161). Brasília: Ibama; UnB/Ceppac; IEB.
Melatti, J. C. (2007). Índios do Brasil [Brazilian indigenous peoples]. São
Paulo: Edusp.
Melatti, D. M. and Melatti, J. C. (1982). A criança Marubo – educação e
cuidados. In E. M. L. S. Alencar (Ed.), A criança na família e na
sociedade [The child in the family and in society] (pp. 38-51). Petrópolis,
Rio de Janeiro: Vozes.
Pisani, M. M. (2009). Algumas considerações sobre ciência e política no
pensamento de Herbert Marcuse [Some considerations about science and
political science in Herbert Marcuse’s thought]. Scientiae Studia, 7(1),
135-158. doi:10.1590/S1678-31662009000100007.
Ricci, C. S. and Scaldaferri, D. C. M. (2014). A conversação na sala de aula
de história [The conversation in the History classroom]. Fóruns
Contemporâneos de Ensino de História no Brasil on-line. Retrieved from
http://ojs.fe.unicamp.br/ged/FEH/article/download/6376/5275.

Robbins, L. B. (1995). O despertar na era da criatividade [Awaking in the age

of creativity]. São Paulo: Editora Gente.
Santiago, A. (2014, May 21). Avanço da tecnologia em aldeia muda cotidiano
de índios no Amapá [Technological progress in a village changes the
indigenous daily life in Amapá]. Retrieved from http://g1.globo.com/ap/
amapa/noticia/2014/05/avanco-da-tecnologia-em-aldeia-muda-cotidiano-
de-indios-no-amapa.html.
Schmidt, E. and Cohen, J. (2013). A nova era digital: Como será o futuro das
pessoas, das nações e dos negócios [The new digital era: How the future
of people, nations and business will be]. Rio de Janeiro: Intrínseca.
Silva, A. A. (2013). Espiritualidade, territorialidade: Interfaces das
representações culturais coletivas indígenas [Spirituality, territoriality:
Interfaces of indigenous collective cultural representations]. Revista Ra'e
Ga, 27, 111-139.
Silva, A. L. (2008). Pequenos “xamãs”: crianças indígenas, corporalidade e
escolarização. In A. L. Silva, A. V. L. S. Macedo, and A. Nunes (Eds.),
Crianças indígenas. Ensaios antropológicos [Indigenous children.
Anthropologic Essays] (pp. 37-63). São Paulo: Global Editora.
Silva, A. L.; Macedo, A. V. L. S. and Nunes, A. (2008). Crianças indígenas.
Ensaios antropológicos [Indigenous children. Anthropologic essays]. São
Paulo: Global Editora.
Sodré, M. (2002). Antropológica do espelho: Uma teoria da comunicação
linear e em rede [The mirror anthropology: A theory of linear
communication and in network]. Petrópolis, Rio de Janeiro: Vozes.
Souza, R. G. (2015). Pré-História Brasileira. Brasil Escola [Brazilian pre-
History. Brazil School]. Retrieved from http://brasilescola.uol.com.br/
historiag/prehistoria-brasileira.htm.
Survival International (n.d.). Brazilian Indians. Retrieved from: http://
www.survivalinternational.org/tribes/brazilian.
The guardian (n.d.). We’re going to resist: Brazil’s indigenous groups fight to
keep their land in face of new law. Retrived from: www.theguardian.com/
world/2015/apr/23/brazils-indigenous-groups-battle-land-law-change.
Todorov, T. (2003). A conquista da América: A questão do outro [The
conquest of America: The question of the other]. São Paulo: Martins
Fontes.
Weigel V. A. C. M. and Lira, M. J. O. (2011). O pajé nas comunidades sateré-
mawé [The shaman in the sateré-mawé communities]. Tellus, 11, 69-77.
Zarur, G. C. L. (2000). Raízes étnicas do Brasil: modelo de integração [Ethnic
roots of Brazil: An integration model]. In Comissão Brasileira Justiça e

Paz and Instituto Brasileiro de Desenvolvimento, História, etnias,

culturas: 500 anos construindo o Brasil: Subsídio apresentado à 38ª
Assembleia Geral da CNBB (pp. 25-44). São Paulo: Edições Loyola.
BIOGRAPHICAL SKETCHES
Name: Eunice M. L. Soriano de Alencar
Affiliation: Institute of Psychology, University of Brasilia, Brazil
Education: Ph.D in Psychology, Purdue University, USA
Address: SHIS QL 10, conjunto 6, casa 14, 71630-065 Brasilia, DF
Research and Professional Experience:
Researcher, Brazilian Council for the Development of Science and

Technology (since 1997)
Guest editor of the journal Gifted Education International (2006)
Vice-president of the Ibero-American Federation of the World Council for
Gifted and Talented Children (1996-2003)
Brazilian delegate at the Interamerican Society of Psychology (1990-
1991)
Brazilian delegate at the World Council for the Gifted and Talented
Children (1985-2000; 2013 – 2016)
Coordinator of the Psychological Science Committee, Brazilian Council
for the Scientific and Technological Development (1989-1990).
Former president of the Brazilian Association for the Gifted Children at
the Federal District (1988-1991)
Editor of the journal Psicologia: Teoria e Pesquisa (Psychology: Theory
and Research (1985) -1986; 1995-1998).
Member of the editorial board of journals in Brazil, England, USA, Peru
and Portugal.
Member of the scientific committee responsible for the organization of
several national and international conferences.

Professional Appointments:
Associate senior researcher – University of Brasilia, Brazil, 2012 –

Professor emeritus – Institute of Psychology, University of Brasilia,
Brazil, 2005 -
Full professor – Graduate Program in Education - Catholic University of
Brasilia, Brazil, 1997-2001
Full Professor – Institute of Psychology, University of Brasilia, Brazil,
1987-1997
Associate professor – Institute of psychology, University of Brasilia,
Brazil, 1972-1987
Assistant professor - Medical School and Philosophy School, Federal
University of Minas Gerais, Brazil (1967-1971)
Honors:
Member of the Permanent Honorary Council, Brazilian Council for
Giftedness, 2003.
Awarded Honorary Citizen of Brasilia, FD, Brazil, 2002. Awarded
Educator of the Year at the Federal District, Brazil, 1998
Several honors received from various universities and professional
associations.
Publications Last 3 Years:
Books
Alencar, E. M. L. S., Bruno-Faria, M. F. and Fleith, D. S. (Eds.), (2014).

Theory and practice of creativity measurement. Waco, TX: Prufrock
Press.
Fleith, D. S. and Alencar, E. M. L. S. (Eds.), (2013). Superdotados.
Trajetórias de desenvolvimento e realizações [Gifted people. Trajectories
of development and achievements]. Curitiba: Juruá.
Book chapters
Alencar, E. M. L. S. (2015). Promoção da criatividade em distintos contextos:

entraves e desafios [The promotion of creativity in diferente contexts:
Hindrances and challenges]. In M. F. Morais, and S. M. Wechsler, S. M.
(Eds.), Criatividade: implicações práticas em contextos internacionais

[Creativity: Practical implications in international contexts] (pp. 15-32).

São Paulo: Vetor.
Alencar, E. M. L. S. (2014). Obstacles to personal creativity inventory. In E.
M. L. S. Alencar, M. F. Bruno-Faria, and D. S. Fleith (Eds.), Theory and
practice of creativity measurement (pp. 21-36). Waco, TX: Prufrock
Press.
Alencar, E. M. L. S., Bruno-Faria, M. F. and Fleith, D. S. (2014). The
measurement of creativity: Possibilities and challenges. In E. M. L. S.
Alencar, M. F. Bruno-Faria, and D. S. Fleith (Eds.), Theory and practice
of creativity measurement (pp. 1-20). Waco, TX: Prufrock Press.
Alencar, E. M. L. S. and Fleith, D. S. (2014). Inventory of teaching practices
for creativity in higher education. In E. M. L. S. Alencar, M. F. Bruno-
Faria, and D. S. Fleith (Eds.), Theory and practice of creativity
measurement (pp. 51-64). Waco, TX: Prufrock Press.
Alencar, E. M. L. S. (2014). Ajustamento emocional e social do superdotado:
fatores correlatos [Emotional and social adjustment of the gifted: correlate
factors]. In F. H. R. Piske, J. M. Machado, T. Stoltz, and S. Bahia (Eds.),
Altas habilidades/superdotação (AH/SD), Criatividade e emoção [High
ability/Giftedness, creativity and emotion] (pp. 149-162). Curitiba: Juruá.
Dantas, L. G. and Alencar, E. M. L. S. (2013). Altas habilidades em
matemática: estudo de caso de um adolescente em vulnerabilidade social
[High ability in Mathematics: A case study of an adolescent with social
vulnerability]. Em D. S. Fleith, and E. M. L. S. Alencar (Eds.), (2013),
Superdotados. Trajetórias de Desenvolvimento e Realizações [Gifted
people. Trajectories of development and achievements] (pp. 13-23).
Curitiba: Juruá.
Guimarães, T. G. and Alencar, E. M. L. S. (2013). Estudo de caso de um
aluno com características de superdotação e transtorno de Asperger
[A case study of a gifted students with Asperger disorder]. Em D. S.
Fleith, and E. M. L. S. Alencar (Eds.), (2013), Superdotados. Trajetórias
de Desenvolvimento e Realizações [Gifted people. Trajectories of
development and achievements] (pp. 109-120). Curitiba: Juruá.
Articles
Alencar, E. M. L. S., Fleith, D. S., Boruchovitch, E. and Borges, C. N. (2015).

Criatividade no ensino fundamental: fatores inibidores e facilitadores
segundo gestores educacionais [Creativity in elementar school: Inhibiting

and facilitating factors according to school principals]. Psicologia: Teoria

e Pesquisa, 31(1), 105-114.
Alencar, E. M. L. S. (2015). Contribuições de estudos de caso para o avanço
do conhecimento sobre superdotação [Contributions of case studies to
the advancement of knowledge on giftedness. Psicologia Escolar e
Educacional, 19(3), 427-434.
Moraes, G. M. and Alencar, E. M. L. S. (2015). Percepção de professores de
língua portuguesa sobre criatividade em produções textuais discentes
[Portuguese teachers’ perception about creativity in students’ textual
productions]. Estudos de Psicologia, 32 (4), 743-753.
Oliveira, Z. M. F. and Alencar, E. M. L. S. (2014). Criatividade na pós-
graduação stricto sensu: uma presença possível e necessária [Creativity in
graduate programs: A necessary and possible presence]. Revista de
Educação Pública, 23, 53-75.
Lima, V. B. F. and Alencar, E. M. L. S. (2014). Criatividade em programas de
pós-graduação em educação: práticas pedagógicas e fatores inibidores
[Creativity in graduate programs in education: Pedagogical practices and
inhibiting factors]. Revista Psico USF, 19, 61-72.
Morais, M. F., Almeida, L. S., Azevedo, I., Alencar, E. M. L. S. and Fleith, D.
S. (2014). Perceptions of barriers to personal creativity: Validation of an
inventory involving high education students. The European Journal of
Social and Behavioural Sciences, X, 1478-1495.
Morais, M. F., Almeida, L. S., Azevedo, I., Alencar, E. M. L. S. and Fleith, D.
S. (2014). Validação portuguesa do Inventário de Práticas Docentes para a
Criatividade na Educação Superior [Portuguese validation of the Teaching
Practices for Creativity in Higher Education Inventory]. Avaliação
Psicológica, 13, 167-175.
Oliveira, Z. M. F. and Alencar, E. M. L. S. (2014). Revitalizando a formação
de professores com a presença da criatividade, sustentabilidade e olhar
transdisciplinar [Revitalizing the teacher training with the presence
of creativity, sustainability and an interdisciplinary view]. Revista
AMAzônica, 14(2), 71-96.
Dalosto, M. M. and Alencar, E. M. L. S. (2013). Manifestações e prevalência
de bullying entre alunos com altas habilidades/superdotação [Bullying
manifestation and prevalence among gifted students]. Revista Brasileira
de Educação Especial, 19, 363-378.
Alencar, E. M. L. S. (2013). Maria Helena Novaes – creative person, creative
life. Gifted Education International, 29.

Boruchovitch, E., Alencar, E. M. L. S., Fleith, D. S. and Fonseca, M. S.

(2013). Motivação do aluno para aprender: fatores inibidores segundo
gestores e coordenadores pedagógicos [Students’ motivation to learn:
Inhibiting factors according to school principals and pedagogical
coordinators]. ETD Educação Temática Digital, 15, 425-442.
Silva, D. S. and Alencar, E. M. L. S. (2013). O docente da educação superior
na área de saúde: formação, satisfação e práticas pedagógicas [Higher
education professors: Training, satisfaction and pedagogical practices].
Revista Educação em Destaque, 4(1), 13-28.
Name: Nívea Pimenta Braga
Affiliation: Institute of Psychology, University of Brasilia, Brazil
Education: Doctoral Student of Psychology, University of Brasilia, Brazil
Address: QRSW 07, Bloco B5 apt 203 Setor Sudoeste, Brasilia, DF.
Professor of High Education – Undergraduate Program in Social

Communication – Institute of Higher Education of Brasilia, Brazil - 2006 -
Coordinator of Junior Advertising Agency – Writing Skills - Institute of
Higher Education of Brasilia, Brazil, 2012 - 2013
Communication – Salgado de Oliveira University, 2006-2009
Copywritter – Advertising Agencies – Belo Horizonte, Minas Gerais,
Brazil, 1999 -2003
Lecturer – Creativity Skills – Brasilia Marketing School (BMS) – Brasília,
Brazil 2013

Communication – Institute of Higher Education of Brasilia, Brazil 2006 -

Honors:
Creative Award – Clube de Criação de Minas Gerais – 2000 Belo

Horizonte, Brazil. Category: Design
Alencar, E. M. L. S., Braga, N., Prado, R. M. and Chagas-Ferreira, J. F.

(2016). Spirituality and creativity of indigenous societies in Brazil and
their legacy to Brazilian culture and creative giftedness. Gifted Education
International. doi: 10.1177/0261429415602581.

Chapter 2
CHILDREN’S SKILLS, EXPECTATIONS

AND CHALLENGES FACING CHANGING
ENVIRONMENTS: AN ETHNOGRAPHIC
STUDY IN MBYA INDIGENOUS
COMMUNITIES (ARGENTINA)
Carolina Remorini*
Universidad Nacional de La Plata and Consejo Nacional de
Investigaciones Científicas y Técnicas, Argentina
ABSTRACT
Mbya Guarani are one of the Indigenous peoples living in the
Argentinian Northeast in the southern extension of the Paranaense
Rainforest, one of the major areas of biodiversity in South America.
However, during the last decades the Paranaense Rainforest has been
under several pressures which has significantly reduced its extent and
has led to major changes in Mbya way of life (Mbya reko). Mbya people
are acknowledged for their deep relationship with the forest. The
transformations in the forest are seen as the main cause of the
discontinuity in the acquisition of culturally relevant knowledge and
skills. This issue is often a recurring theme in the speeches of elderly
* Corresponding Author address: Avenida 122 y 60. CP 1900. La Plata, Argentina; Email:
carolina.remorini@gmail.com.

32 Carolina Remorini
leaders who claim for the recovering of spheres for learning the Mbya
reko.
Facing these speeches that emphasizes the generational discontinuity
in cultural learning, our ethnographic study accounts for the vitality of
knowledge and skills highly valued in the context of the Mbya way of
life. In other words, children’s engagement in routine subsistence
activities, which present a high potential for learning of local knowledge
and for the process of enskillment, continue to be predominant. These
processes are directly linked with the individual’s involvement in their
environment, throughout careful observation and participation in
activities performed by multi-aged groups of people. In this framework,
“traditional” knowledge and practices are not only reproduced but also
continuously transformed in creative ways. However, Mbya children also
engage in other activities such as school or entertainment, which are
considered “non-traditional.”
The data analyzed in this chapter come from observations,
interviews, drawings and models produced by children from Mbya
communities. Considering this background, this chapter first describes
some settings in which children learn about their way of life, in the
framework of interactions with peers and more experienced people.
Second, it explores how drawings and models made by children can tell
stories about children´s preferences, expectations and future horizons.
Finally, the chapter reflects on how intergenerational and peer
interactions involve transmission, adaptation, questioning and innovation
of knowledge and skills necessary to dwelling in changing environments.
Moreover, how elderly knowledge and advice are acknowledged by
children and young people for exploring new opportunities in the
globalized world. Based on that, we discuss elders’ ideas about the
discontinuity of learning and stress the relevance of taking into account
perspectives of both children and youth to understand the contemporary
Mbya way of life in the framework of ecological changes.
INTRODUCTION
According to the Ecology of Human Development (Bronfenbrenner,
1987), children’s development is a result of their participation and engagement
with their environment; they are both shaped by and actively shape their
environments (Settersten, 2002; Rogoff, 2003; Weisner, 1984). The Ecology
of Human Development relates patterns and pathways of development to the
enduring and changing environments in which people live (Bronfenbrenner,

Children’s Skills, Expectations and Challenges … 33
1987; Elder and Rockwell, 1979). In that framework it is assumed that

learning processes are sensitive to changes in people’s environment
(Greenfield et al., 2003).
Contrary to conventional approaches to child development, based on the
idea that the environment influences the child, for the Ecology of Human
Development the unit of analysis is the child-in-its-environment as a whole,
not as separate entities. Children are engaged in their environment through
their participation in routine activities which requires the learning and practice
of different skills (Ingold, 2000; Rogoff, 2003). As each ecology emphasizes a
different set of “skills” and, consequently, diverse developmental pathways,
learning processes accompany transformations in ecological conditions. It
implies that different socialization patterns and goals are necessary to prepare
children for an environment different from the one in which their parents and
grandparents were raised. In this regard, contemporary small scale societies
facing rapid ecological change provide a unique opportunity to study the
relation between ecological changes and the process of acquisition of local
knowledge (Gallois et al., 2015).
Scholars have argued that daily life experiences are essential for the
acquisition of cultural knowledge as they shape not only the kind of
knowledge being learned, but also the way such knowledge would be learned
along the lifespan (Gallois, et al., 2015). Considering that, this chapter aims to
account for children´s perspectives and expectations about their living
conditions at present and future, in the framework of their involvement in
routine activities and community settings. Based on our ethnographic
observations and records of children’s daily experiences, we reflect on how
intergenerational and peers interactions involve transmission, adaptation,
questioning and innovation of knowledge and skills necessary to dwelling in
their changing environments. In addition, the chapter explores how drawings
and models made by children can tell stories about Mbya current way of life,
children´s preferences, expectations and future horizons.
Building off these ideas, this chapter is divided into three parts. In the first
part, I describe the Mbya communities we have studied, the ethnographic
background and the methodological strategies applied. In the second part, I
examine children’s learning process in the framework of their participation in
routine activities, being those considered “traditional” or “nontraditional.” I
provide several examples coming from our ethnographic record that allows us
to recognize inner variability in contemporary children’s experiences in
different settings, including formal education institutions. The aim of this

section is to provide evidence that supports our main argument: considering

elderly’s speeches that emphasize the discontinuity in cultural learning, our
ethnographic data highlight the vitality of knowledge and skills highly valued
in the context of the Mbya way of life (Remorini, 2009; Remorini 2015a),
even when Mbya children increasingly also engage in other activities, such as
school or entertainment/leisure, which are considered “non-traditional.” In the
third part, I analyze children’s drawings and models which account for their
daily experiences and perspectives on their present and future. Based on that,
at the end of the chapter I discuss elders’ ideas about the discontinuity of
learning and stress the relevance of taking into account of both children and
youth perspectives to understand the contemporary Mbya way of life in the
framework of ecological changes.
1. THE SCENARIO
1.1. Mbya Way of Life in a Changing Environment
The Mbya inhabit the Southern extension of the Paranaense

Rainforest, one of the major areas of biodiversity in South America.
However, during the last decades the Paranaense Rainforest has been
under several pressures derived from livestock colonization, selective
extraction of timber, replacement of native forests by exotic tree plantations,
agricultural colonization -especially tea (Camelia sinensis), yerba mate (Ilex
paraguariensis), tobacco (Nicotiana tabacum), and tung tree (Aleurites fordii)-
, and the installation of hydroelectric dams and other industrial enterprises
(Crivos et al., 2007). This situation has significantly reduced its extent and has
led to major changes in the Mbya way of life (Mbya reko).
According to most recent estimates, the Guarani total over 6500 people in
Argentina, with high and sustained growth rates (Grumberg, 2008). Their
language belongs to the Tupi-Guarani linguistic family. Mbya language is
spoken within Argentinian communities, and most adults and schoolchildren
also speak Spanish, and less frequent, yopara (paraguayan Guarani) and
Portuguese.
The Mbya presence in Misiones Province (Argentina) dates back to the
end of the nineteenth or beginning of the twentieth century, when they moved
from the southeast of the current territory of Paraguay, to Argentina and
Brazil, significantly expanding its territory (Garlet, 1997; Remorini, 2001).

Although they maintain a wide variety of relationships with other people (at
local, regional and international levels) Mbya people are acknowledged for
their deep relationship with the forest (“monte” or kaáguy). They do not just
live in the forest; they consider themselves – together with other living beings
- part of this environment, which is essential from their point of view for the
continuity of the Mbya reko (Mbya way of life). The expression Mbya reko
refers to cultural practices learned and performed throughout generations,
including the appropriate ways of dwelling (Ingold, 2000) in the forest and
relating with the forest’s inhabitants.
Ethnographic and historical studies about Mbya people have emphasized
their constant spatial mobility as they make use of the rainforest resources and
search for areas having favorable conditions for Mbya reko. In spite of the
current reduction in the extent of the rainforest, Mbya subsistence is still
based on the combination of hunting-gathering-fishing and “slash-and-burn”
horticulture, although dedication to these activities varies according to
communities’ location and the impact of government policies. Handicraft
selling and temporary paid jobs in ‘colonias’ (small rural areas devoted to
agricultural production and livestock rearing contribute to the maintenance of
most households. Some individuals receive allowances and some get a salary
from being teaching assistants or sanitary agents. The money obtained from
either activity allows them to obtain industrially elaborated supplies (flour,
sugar, pasta, rice, beans, cold cuts, sodas, candy, among others) and has
resulted in a lesser degree of commitment to traditional food-obtaining
activities, as well as important dietary changes (Remorini, 2009).
The family organization is based on the patrilocal extended family,
although uxorilocality and neolocality are also common. Most of the houses
inhabited by members of an extended family are located close in space or
sometimes around the same courtyard. This spatial arrangement facilitates the
three generations often sharing household chores and grandparents having an
important role in childrearing. Girls stay close to their female relatives,
learning domestic tasks at an early age. For their part, boys older than two
deepen their relationships with their fathers and other male relatives, and share
with them various activities. In conclusion, different from western and urban
context in which opportunities for nurturing tight and lifelong relationships
between the older and the younger people are quite rare, in these indigenous
communities the integration of ages still prevails.

1.2. Rationale behind the Study of Children´S Perspectives and

Experiences in Changing Ecological Environments
Cultural Anthropology and Psychology has countered classic perspectives

of childhood with new theoretical and methodological frameworks, generating
highly productive analysis and reflections on the way in which indigenous
children conceive of and experience the contemporary world. In this line, this
chapter follows some ideas and concepts about children’s learning and
enskillment proposed by Toren (1993), Lave (1995), Ingold (2000), Rogoff
(2003, 2014) and Paradise and Rogoff (2009). All of them are, in turn,
coherent with an ecologic approach to children’s development.
Central to this chapter’s argument is the idea according to which the
persistence of traditional ways within changing cultural communities allow
people able to learn and use different skills which make them fluent in more
than one way (Rogoff, 2003). As Toren (1993) pointed out,
“… the processes through which children constitute themselves as

adults are fundamentally open-ended (…) In other words, human
cognition is a historical process because it constitutes - and in constituting
inevitably transforms- the ideas and practices of which it appears to be
the product” (Toren, 1993: 461-462).
In that framework, concepts such as knowledge “transmission” or

“acquisition” are under criticism, due to current ecological perspectives that
claim that we can better understand the dynamics of human development –and
also of cultural change- if we consider them as a result of practice and training
during participation in specific settings or environments. Instead of cultural
knowledge “transmitted” and imposed upon the individual’s experience, the
individual’s experience in specific settings is the locus of analysis (Crivos and
Remorini, 2007; Remorini, 2015a). This distinction holds importance for
understanding the emergence of new ideas facing new environmental
conditions. In the conventional, dualistic vision of socialization, people’s
perception and understanding of the environment would derive from cultural
constructions transmitted through generations as a homogeneous and
invariable corpus, relatively impervious to the actual constraints and features
of specific activity settings. In other words, impervious to time and history
(Ingold, 2000; Remorini, 2015a).
Recent studies have highlighted that children have an enormous capacity
of selection and transformation; hence the results are not homogeneous.

Following Ingold (2000) children should not to be seen as merely produced or

made by culture or society. Contrary to mechanic perspectives of socialization,
adults’ practices provide environmental conditions for promoting children’s
learning and development but do not determine the process and the results
(Ingold, 2000). Otherwise, children’s ability to innovate as well as to make
autonomous decisions in learning would be limited (Remorini, 2015a).
In spite of the growing research centered on children’s perspectives about
different issues, until the last two decades1 the main source of studies about
Mbya culture and its transformations were speeches of leaders that emphasized
adults’ and elderly´s “word” shadowing the perspectives and practices of other
actors, including children (Remorini, 2015b).
In this chapter I attempt to argue that children’s perspectives, expectations
and daily experiences deserve the same attention than those of adults and the
elderly. First, because as social actors participating in various domains of
culture, their perspectives and experiences interact, complement or contrast
with the perspectives of other members of the community. Children have to be
considered as actors who can provide a unique perspective on the social world
and about topics that concern them as children. In this sense, we agree with
Toren (1993) when states:
“It makes no sense to dismiss children's ideas as immature, or to

argue that they do not understand what is really going on. Children have
to live their lives in terms of their understandings, just as adults do; their
ideas are grounded in their experience and thus equally valid.” (Toren,
1993: 463).
Second, as several scholars have shown, especially in small-scale

societies, what is called “traditional ecological knowledge” is learned during
childhood (Gallois, et al., 2015). This traditional knowledge of the
environment and its management, range from only knowing the names of the
species to knowledge that deals with technical mastery, i.e., with skills to
manage these resources (Setalaphruk and Price, 2007). Ethnography and
ethnobiology have documented the early training of children in survival skills,
through observation and participation in subsistence activities (Ruddle et al.,
1977; Hewlett and Cavalli-Sforza, 1986; Hawkes, O’ Connell and Blurton
Jones, 1995; Mignot, 1996; Zarger, 2002; Rogoff, 2003; Rogoff et al., 2007;
Gaskings, 2000; Hunn, 2002; Waxman et al., 2007; Paradise and de Haan,
1 In the case of Mbya communtities from Argentina, we can mention the research conducted by
Cebolla Badie (2000) as well as Padawer and Enriz (2009).

2009; Cervera, 2009, Wyndham, 2010; Lancy, 2012; Ruiz-Mallen et al., 2011;
and Taverna et al., 2012; Morelli 2013). Our own research provides with
evidence that support the idea of environmentally relevant knowledge and
skills are learned during infancy and childhood (Remorini, 2009; 2014; 2015a,
b). We have described how the process of learning and training of different
skills to inhabit the forest begins in childhood but is continuously actualized
through practice in changing environmental conditions. Mbya children’s and
adults’ direct experience with the forest and its inhabitants is the basis of new
learning, and because of the forest’s changing conditions this kind of learning
is fundamentally different than learning based on a model of transmission of
information (Remorini, 2015a).
Third, the current pressures on the forest environment form, together with
other conditions at micro and macro level, shape the particular ecological
setting in which children’s life and development occur. In relation to this,
research on children’s perspectives and daily experiences could show the inner
diversity that depict Mbya communities throughout the province. By focusing
in the ways children talk about their environment, we can assess the extent
to which “traditional” knowledge and practices remain vital while being
continuously transformed in creative ways. Talking with children during our
fieldwork, we also recognized the articulation raised by children and
youngsters between traditional and innovative components of their lifestyle, in
the framework of a regional context which presupposes a high demand for
“traditional knowledge” to be applied to new economic enterprises, including
handcrafts selling, natural resources management and ethnic tourism.
1.3. Research Context and Ethnographic Material
The data presented here come from ethnographic fieldwork conducted

in Mbya communities of Misiones since 2001. It was mainly oriented to
the study of knowledge, values and practices regarding childrearing and
child development. We have focused on children’s daily experiences and
childrearing practices within the framework of subsistence activities and
intergenerational relationships at domestic scope. For that purpose, we applied
several ethnographic techniques for data collection (systematic non-structured
observations, structured observations, spot observations and open-ended
interviews mainly) and record (audio, video and photography).

In that framework, we also carried out an extension project2 aimed to

addressing the central issues posed by Mbya-Guarani leaders: the discontinuity
of learning of “traditional” knowledge and practices. We decided to use
drawings as an initial strategy to inquire about children´s points of view.
According to Cohn (2005) and Morelli (2011) drawings can reveal what
children are interested in, concerned with and makes available things that
are difficult to explain verbally. By performing drawings, models and
conversations with children and adults, we started to talk about the community
history (“Aldea kue” or “tekoá kue”)3, their present way of life (teko) and its
expression in the teko’a (village)4, as well as their expectations for the future.
In order to recognize children’s concerns and expectations we suggested to
them three tasks to produce the drawings and models: 1. To make a map or
sketch of the teko’a; 2. To represent what they like most of the village in
which they live; 3. To represent what they would like their community to be
like in the future (Remorini and Teves, 2013).
We obtained 156 drawings, mostly made by boys between 7 and 13
years-old. We recorded conversations maintained with them during their
performance, based on the contents of their drawings. After this activity, we
also asked teachers and elders to provide us with their interpretations of what
was produced by children. As a result, the activities performed allowed
us to reconfigure the problem, by focusing on intergenerational knowledge
exchange and re-valorization of what children think about the current contexts
in which they participate and their future expectations. Also, these activities
highlighted particular children’s conceptions of their teko’a and the forest
(kaáguy) and the ways of inhabiting them, which has furthermore helped us to
reflect on the limitations of traditional ethnographic approaches to Mbya
culture (Remorini and Teves, 2013).
2 Project “INTERACTUANDO. Estudiantes de la Universidad Nacional de La Plata al servicio

de las comunidades Mbya- Guaraní de Misiones”. (Interacting. Students of the National
University of La Plata at the service of Mbya-Guaraní communities of Misiones), Directed
by Laura Teves and Carolina Remorini. Secretaria de Políticas Universitarias. Ministerio de
Educación, Ciencia y Tecnología. República Argentina.
3
Kue: in guarani language this suffix means “what used to be”. In that context, it means “the
older village” in which elders grew up and lived.
4 Teko is a term with multiple meanings which refers to human life, the way of living and the
conditions to make possible this way of living. Teko’a is usually translated as “village” or
“community” or “patrilineal kin group”. However, a more appropriate translation, according
to Mbya understanding, could be “the place in which teko is performed”. For a more
detailed analysis see Remorini (2009).

2. MBYA CHILDREN´S EVERYDAY LIFE: ENSKILLMENT

WITHIN THE FRAMEWORK OF SHARING ACTIVITIES
Extensive and systematic ethnographic observations of children’s

everyday life, accounts for the diversity of childhood experiences in
different Mbya communities of Argentina (Remorini, 2009; Remorini and
Teves 2013; Remorini and Rende, 2014). Based on that, I argue that children’s
engagement in routine subsistence activities, which present a high potential for
learning of local knowledge and for the process of enskillment, continue to be
predominant. These processes are directly linked with the individual´s
involvement in their domestic environment, throughout careful observation
and participation in activities performed by multi-aged groups of people
(Rogoff, op.cit; Paradise and de Haan, 2009).
In this section, I examine children’s learning process in the framework of
their involvement in routine activities, being those considered “traditional” or
“non-traditional.” For that purpose, I present some examples coming from our
ethnographic record of household routines to highlight different settings for
children’s learning and the kind of knowledge and skills resulting from them.
Meetings Around the Fireplace (Tatapy)
In Mbya language, tatapy (fireplace) is not merely the place in which fire
is lit for cooking meals or heating the house. This expression metaphorically
refers to the community (teko’a). Every night the members of an extended
family meet around the fire and talk about the day events and activities done
by each one. Most of the time, the elderly use the occasion to “teach”
something to the youngest. Also, they take the opportunity to share with them
stories and myths. Children and youth carefully listen to them, trying to
understand the meaning of some words which they are not accustomed to
using in everyday language. When asking adults and elders about this practice,
they highlight its relevance for teaching “the true way of life” to younger
generations who used to “forget” it. This point of view reinforce the elders’
ideas according to which “the beautiful-sacred words” (Ayvy Pora) are the
main vehicle for learning the “traditional” way of life. Rhetoric competence is
highly valued as the individual progresses through the life-span. In some way,
these situations promote a kind of learning children need for participating in
several rituals, which implies the understanding and correct use of sacred

words. Even when little children are not able to understand them, they actively
participate in these meetings through carefully listening and paying attention
to others’ speeches. As a young boy reflected: “sometimes… we don’t
understand what the elders say … they speak with words we don’t understand,
with old words...” (younger boy, 13 y.o). However, from the perspective of the
children and youngest these meetings are valued as opportunities for listening
and learning “moralejas” (morals) which they can invoke in the future.
"When I was a mitãi (little child) I remember my grandfather, my

grandmother… in the early evening all the kids always came and they
gave us some advice ... we were meeting around the fire, and my
grandfather told a story or a moral, which teach us a lesson… thinking
about our future ... when you're a kid you do not understand, then they
don’t explain so much but when you grow instead ... time gives you
understanding" (younger boy, 16 y.o).
By their part, an adult man remembers: “Since I was a little kid I’ve liked
listening to my grandparents’ stories, advice, legends and myths through their
words. These lessons teach us how to live together, about biodiversity, beliefs,
ways of life, art, music, dancing and respect for the traditional authorities”
(teaching assistant, man, 26 y.o).
The process of growing up, or in other words, of becoming a Mbya
requires adult guidance and support. Besides this, to becoming a Mbya
children need to learning and training in some skills crucial to inhabit the
forest. These skills are simultaneously physical, cognitive, social and
perceptual. In Mbya language, “kakuaa” means “to grow” but also “to know,
to understand.” In this sense, a mature child is one who has achieved
understanding. As the child develops “kakuaa” (understanding), she/he is able
to collaborate with others and to perform different activities (Remorini,
2015a). In what follows, I describe some other contexts in which children
daily learn about “Mbya reko” through their active involvement in several
tasks as they gain new competences.
Excursions to the Forest
Routine activities and displacements together with adults and peers

become relevant experiences for children in terms of opportunities for learning
physical skills to inhabit the forest environment. From Mbya point of view,

walking is not merely a physical skill. Walking is a way to “experience the

world” (Cf. Cadogan, 1997)5. Learning to walk in the forest implies putting
into play a variety of sensory and cognitive skills such as keen observation and
active listening, but also the ability to recognize differences in smell and taste.
Learning to walk through the forest is a crucial skill to grow up as a Mbya.
Learning to walk is especially important because girls and boys participate
from a very early age in gathering and horticulture, accompanying adults and
doing some “simple” tasks such as helping to clean or to put the seeds in the
holes made by adults with the digging stick. In accompanying adults in
gathering, children develop sensory and perceptual skills such as taste and
smell involved in the recognition and collection of medicinal plants. Hunting
is probably the activity that requires the most complex abilities; it involves
different tools, such as traps, bows and arrows (less frequent today) and
firearms (more recently). Each technological choice implies a deep knowledge
about the habits of prey, their vulnerabilities, and the environments they
frequent (Cebolla Badie, 2000; Rival, 2001; McDonald, 2007; Remorini,
2015b). Consequently, hunting is an activity in which boys are involved later
in childhood. Children´s gradual involvement in activities with different levels
of complexity allows them to develop environmentally relevant skills over
time, ranging from recognition of animal’s footprints to building a trap
(Remorini, 2015a).
Also children older than 5 y.o. participate in excursions to gather fruits
with peers in tree areas near their houses. Some of these areas are within the
village, and others are located on the border between the village and the
“colonos” (settlers) private properties. Unlike other gathering trips in the
forest these excursions never involve adults. Children collect especially
tangerines and oranges from the tallest trees, helping with sticks of different
length, and once collected they consume them during the journey, and the
remaining are brought to share with other members of their household. Most
of the times, these excursions take place after or before children go to swim,
play, fish and/or wash clothes to the streams that run through the village.
“Non-Traditional” Activity Settings
Although children are still involved in the chores and settings described
above, they also spend their time in other spaces with peers or adults coming
from outside the community.
5 For more detailed development of this idea see Remorini 2009, 2010 and 2015a.

For instance, in many communities get usual visits from people belonging
to NGOs or other religious, charitable or political organizations. Also, we can
see tourists, especially in those communities nearby highways and urban
centers. On their visits to the community these “outsiders” basically make
contact with children and they deliver food, clothes, and toys and with these
materials they organize different activities such as cooking, self-cleaning and
games with the little Mbya kids. Moreover, tourists are especially attracted to
children who are at the kiosks selling crafts with their parents.
It is interesting to note adults' openness towards foreign visitors. Such
attitude makes us think about the advantageous effect this attitude may trigger
in younger generations. Probably little children are stimulated by their own
curiosity. But at the same time, we recognized that this approach toward
outsiders is promoted and enabled by elders. Indeed, children are the ones with
whom NGOs and tourists first interact. In this respect, in some drawings made
by children representing the village depictions of kiosks stand out “for tourists
who visit us and buy our crafts” (girl, 7 y.o).
Another setting in which children daily interact with “ousiders” is school.
The school is in charge of “criollos” (mestizo) teachers and indigenous
teaching assistants. The indigenous assistant is usually in charge of choosing
different topics of Mbya culture -with the guidance and advice of village
elders- to work at classroom depending on the children’s ages and grades,
attempting to adapt the curriculum to the expectations of the community. He
explained to us: "I’ve planned these activities thinking that the child's reality
today is far from the way of life of past generations" (teaching assistant, man,
26 y.o)
Regarding the role of school in children’s education, we recorded
generational transformations in parental ideas about the activities in which
children should get involved and collaborate in family chores and educational
expectations, based on parents’ different schooling trajectories. Generally,
school attendance is subordinated to other activities that adults and children
consider a priority for themselves or their household. According to our
observations, school is a place where we can see how the vision on the
“traditional culture” is negotiated in reference to the topics included in the
syllabus. For instance we could observe a meeting in which both, teachers and
indigenous assistants, discussed different perspectives on topics such as human
development and life cycle, and the best ways to teach them to children.
On the other hand, in the speeches of teaching assistants and young people
interviewed expectations about school and their role in preparing children as
future leaders and professionals emerged. Moreover, in these speeches the

emphasis was not placed in a distinct or culturally oriented education, but in

getting an education of the same quality as “jurua” (the non-indigenous
people) children receive, which will allow them to have the same opportunities
as other non-indigenous children and youngsters. In this regard, a young leader
stated:
“Studying doesn’t mean resigning oneself to being who we are, or

resigning oneself to being a Mbya. On the contrary, being a professional
can become a valuable tool for Mbya people, because we learn how to
better defend our people. That’s why youngsters’ education is very
important” (man, 25 y.o)
3. FROM ALDEA-KUE TO THE FUTURE

As a result of the activities implemented in the framework of the project
described above, we obtained drawings and models which allowed us to access
to both children and youth preferences, daily experiences, expectations and
perspectives around their present and future life. We asked them two main
questions: 1) What do you like most of the teko’a where do you live? and 2)
How do you imagine your teko’a in the future?
Table 1 shows the items mostly represented in children´s drawings. While
younger children were making drawings about the village, some older ones
spontaneously started to draw sketch maps of the village (Figures 1 and 2).
The maps and the drawings highlight the different paths connecting the houses
and different spaces (soccer field, school, sanitary post, streams and other
water sources) as well as the route that connects the village with other towns in
the province and nearby countries. These towns are often visited by children
with their parents who go there to sell crafts and buy "provita" (food and other
supplies). In some drawings in which the route appears also trucks of the
sawmills stand out. These sawmills, which are responsible for the cutting
down of forest trees nearby the community, represents a serious concern for
children and adults. Unlike fixed structures (houses, school) the spaces that
allow people’s displacement acquire central role in the drawings and models.
Soccer fields also stand out for their size (Figures 3 and 4). In terms of boys’
sociality, soccer matches and tournaments are opportunities for them to
moving between different Mbya villages and meeting other people with
different customs, which account for the relevance given to interacting with

“outsiders” as well as their “paisanos” (Mbya people) who live in diverse

teko’a.
Table 1. Themes and items represented in children´s drawings
Items/theme Frecuency
Trees / Flowers/ Fruit trees[1] 26
Soccer game and field 18
Houses 15
Tekoá (sketch) 14
Rivers / Streams 13
Birds 12
Route + Trucks[2] 10
Services (lighting, antennas, buses, health center) 9
Pindo palm[3] 7
Other animals 6
Amusement park / Playground / Places 6
Children at Play 4
Buildings (4) 4
Catholic symbols 4
Helicopters / Airplanes 3
School 2
Kokue (vegetable garden) 1
Livestock farming 1
Opyguã house 1
Total 156
References:
[1] Citric trees predominate (tangerines).
[2] Trucks which transport tree trunks from deforestation areas
[3] Arecastrum romattzoffiana sp: Palm tree which is relevant in Mbya Guarani’s
cosmology.
[4] Two children specified that the buildings they drew were hospitals and schools.
The two young boys (12 y.o and 14 y.o) who made the village maps could
also point at each of the inhabitants of the houses that they drew in the sketch,
establishing kinship relations between them. The emphasis put on the
pathways and roads accounts for the centrality of movement and walking as an
everyday experience and as a tracer of individual development (Remorini,
2001; 2009; 2010; 2015a). As we described in the previous pages, through
walking in the forest children develop several skills. Besides, walking through
the village by using the paths connecting houses, tree areas, streams and public
buildings, is a daily experience for children as they spend their time running
errands, visiting relatives, playing with neighbors, distributing food or going to

school. These everyday displacements allow children to gain knowledge not

only about the space and the forest resources but also about people
relationships which have implications for the village social organization.
Figure 1.
Figure 2.

Figure 3.
Figure 4.

In drawings made to answer the question: “What do you like most of the
teko’a where do you live?”, trees, fruits, birds and streams besides soccer
fields are mostly represented (Figure 5). Among the trees, the citrus species
introduced by “colonos” (settlers) stand out, which is related with children’s
frequent trips to collect tangerines in peer groups as we described above.
Pindo palm tree (Arecastrum romattzoffiana sp) is the only native species that
stands out. This species has a deep meaning for Mbya cosmology. Due to the
increasing deforestation processes affecting the Paraneese rainforest, these
palm trees are not easy to find at present.
Figure 5.

In several drawings representing trees and birds, as well as in those

depicting scenes of play in the streams, children wrote in Spanish the
expression “Estoy feliz” (I'm happy) (Figure 6). When asking teachers and
elders about their interpretation of these expressions, they associate them with
the idea of still posessing the forest, with a great diversity of species.
Following this reasoning, adults and elders concluded that what children like
most in their village is connected with ideas such as lack of pollution and
high biodiversity, allowing us to recognize a certain idealized vision of the
environment proposed by adults, which does not necessarily correspond to the
vision of children.
Figure 6.

In relation to the lower dedication to traditional subsistence activities in

one of the villages, the underrepresentation of traditional species in the
drawings is noticeable. Only one drawing refers to traditional agriculture
(kokue: traditional crop field). Instead of this, the majority of drawings show
species of plants and animals introduced by “colonos” along with farmyard
animals introduced as a result of NGOs projects mostly. In this regard, the
drawings of children from this village are expressive of the lower dedication
of their parents to traditional subsistence chores. Additionally, just one
drawing represents the Opy (Mbya church) while there are drawings
representing catholic symbols, which reflect the growing presence of religious
organizations in some Mbya villages. However, the most interesting aspect is
that there was no Opy in this village at the time we made our research. Despite
this, the child who made the drawing decided to include it in the village sketch
because it represents "what should be in every teko'a" as well as the Pindo
palm tree, even when deforestation is putting those trees at risk.
Finally, in reference to the question: “How do you imagine your village in
the future?” the drawings show the presence of traditional species in the
village along with items related to entertainment and public services such as
ambulances, health centers and electricity, among others. (Figures 6 to 8)
Considering the topics represented in the drawings, we argue that they
show children genuine interest in having spaces for fun, by taking advantage
of areas already available nearby the streams and by introducing in the village
some “jurua” items such as amusement parks and squares. At the same time,
drawings express their demand for services they need to improve their quality
of life. One drawing show the Opy surrounded by modern buildings, and a
person driving a car. Regarding this, the teaching assistant reflected:
“We or they in the future can change material things, but they will always
keep their culture, their identity. If an Opyguã drives a car that does not mean
he will stop being our spiritual leader”
In this sense, drawings highlights the mixture depicting Mbya villages
at present that seeking for interweave the traditional Mbya way of life and
some novelties coming from “the jurua way of life.” This openness to
otherness we have mentioned before is also represented in some drawings in
which children drew buildings that could serve as hostels for “outsiders,
tourists or researchers.”

Figure 7.

Figure 8.
CONCLUSION
“…at the beginning, I think we (elders) were the ones who showed
the best way to children, to our grandchildren. Well, now I realized they
will be the ones who will lead us, from their own vision, as they
expressed in their drawings… (Opyguã)
As I stated at the beginning of this chapter children’s learning processes

accompany transformations in ecological conditions leading to different
developmental pathways. Children’s daily experiences and challenges in
contemporary indigenous communities of Latin America have become a
relevant topic of interest for anthropologists and ethnobiologists concerned
with indigenous peoples’ strategies to cope with environmental changes.
Regarding this, a growing number of research account for the variety of
situations that might prevent children to learn relevant knowledge and develop
skills related with their environment such as formal schooling, new leisure
activities oriented to children and youngest, new economic enterprises,
introduction of foreign species and reduction of traditional territories (Zarger,

2002; Setalaphruk and Price, 2007; Ruiz-Mallen et al., 2011; and Taverna et
al., 2012; Morelli 2013; Gallois, 2015).
The ethnographic study of learning processes in everyday life in small-
scale indigenous communities could contribute to the discussion around the
relationships between ecological transitions, biodiversity loss and breakup in
children’s learning about their environment and “traditional” life styles. In this
regard, observation and record of those activity settings in which children
get involved might provide insights regarding the process of learning
environmentally relevant knowledge and skills in facing current ecological
transitions. It also could help to understand the inner variation in children´s
learning experiences, avoiding generalizations that might overshadow the
diversity of current strategies for living.
Far from some visions crystalized in leaders’ speeches about learning
breakup, the results analyzed in this chapter highlight the vitality of knowledge
and skills highly valued in the context of the Mbya way of life, even when
Mbya children increasingly also engage in other “non-traditional” activities,
such as school or leisure. Moreover, our characterization of children’s
everyday life experiences and perspectives allows us to support the fact that
contemporary Mbya way of life is an example of an active seeking for
articulating traditional and innovative knowledge and practices. Even when
moving between different frameworks could be a source of stress and conflict,
at the same time it enables people learn and use different knowledge and skills
which make them fluent in more than one way (Rogoff, 2003). In other words,
it provides cognitive and social flexibility for new synthesis of cultural ways.
In this regard, our study suggests new lines for further research on
children’s pathways of development which would enable us to better
understand the interplay between traditional and non-traditional activities and
predict their impact on learning processes in these small-scale societies.
Longitudinal data would be needed to assess the long-term impact of activities
that have been recently introduced as part of Mbya life strategies on children´s
development and learning.
However, our work could be seen as a first approach to the topic in the
communities under study. Through the methodology implemented we noticed
children’s ability to move between different frameworks, as it is expressed in
their drawings and models. They showed the current variety of people,
activities and social interactions that shape their life in the teko’a (village). On
the other hand, they expressed some demands for improving their quality of
life without questioning the value of traditional components of their way of
life.

As pointed out by Cohn (2005: 10) "... children reconstruct on paper the
world they live in, recovering in his compositions the diversity and plurality of
aspects and domains of life as they conceived, whether ritual or daily activities
and their material support. They are not interested in culturalist purism .... but
portray the vitality of daily life in their villages.” According to Morelli (2011:
1) in drawings “... any object, action and element disclosed by the images does
not make sense on its own terms, but only within a referential whole of other
tools, places, materials and practices.” In this sense we must consider
children’s perspectives within the framework of the current challenges for
indigenous peoples, the plurality of images and discourses around indigenous
identity and rights promoted by government and non-government agencies, as
well as the uncertainties of the future and the legacy of their history.
Working with children has opened a different but complementary
perspective on the problem of learning, which allows us to discuss how adults
and elders approach the topic. An innovative instance was to join them to
analyze the scenes drawn. This experience has enriched the exchanges and
discussions around topics introduced by children in their drawings and models.
The drawings together with our observation of activities performed by
children showed that "aldea-kue" represents a lifestyle that children do not
fully participate nowadays; however it accounts for the past experience of their
parents and grandparents, which is one of the main topics of the night
meetings around the fireplace as described above. As it occurs at present, the
future village should interweave the visions of elderly and young people.
Elderly knowledge and advice become relevant to children and youngsters
for exploring new opportunities in the framework of new government and
NGO’s initiatives regarding land claim, sustainable resources’ management,
education, ethnic tourism and handicrafts selling. Indeed, the idealized vision
of the forest and traditional culture sustained in several speeches become a
central argument for claiming land rights, contrasting the indigenous way of
life with “jurua” way of life.
In this chapter I defended the idea of learning as the result of children’s
engagement in their environment against ideas such as “knowledge
transmission” or “acquisition”, as processes outside of the historical and
ecological constraints. The ethnographic data presented here account for the
diversity of learning environments that children and youngsters participate in
within the Mbya communities. Each of them implies a set of social
relationships, activities and goals which are continuously changing and
updating, enabling children and young people to move through them and
therefore develop different pathways as individuals. The legacy of elders is

always an anchoring point which allows them to explore new ways of

becoming a Mbya that are consistent with the new challenges and
opportunities for indigenous peoples.
REFERENCES
Bronfenbrenner, U. (1987). La ecología del desarrollo humano: Experimentos
en entornos naturales y diseñados. Barcelona: Paidós.
Cadogan L. (1997). Ayvu Rapyta. Textos míticos de los Mbyá-Guaraní del
Guairá. Asunción: Fundación León Cadogan.
Cebolla Badie, M (2000). El conocimiento Mbya-guarani de las aves.
Nomenclatura y clasificación. Suplemento Antropológico XXXV (2), 9-
188.
Cohn, C. (2005). O desenho das crianças e o antropólogo: reflexões a partir
das crianças mebengokré-xikrin. Proceedings of VI Reunião de
Antropologia do Mercosul, 6. Montevideo: RAM.
Crivos, M. and Remorini, C. (2007). Entre el individualismo y el colectivismo.
El contexto de la acción en la etnografía funcionalista y en la filosofía
pragmatista. In: J. Ahumada, Pantalone and Rodríguez. (Ed.),
Epistemología e historia de la ciencia: Selección de trabajos de las XVI
Jornadas (pp. 173-179). Córdoba: Universidad Nacional de Córdoba.
Crivos, M., Martínez, M.R., Pochettino, M.L., Remorini, C., Sy, A. and
Teves, L. (2007). Pathways as “signatures in landscape”: Towards an
ethnography of mobility among the Mbya-Guarani (Northeastern
Argentina).” Journal of Ethnobiology and Ethnomedicine, 3 (2),
http://www.ethnobiomed.com/content/3/1/2, doi:10.1186/1746-4269-3-2.
Elder, G. and R. Rockwell. (1979). The Life-Course and Human
Development: An Ecological Perspective. International Journal of
Behavioral Development 2: 1.
Gallois, S; Duda, R; Hewlett, B and Reyes-García, V. (2015). Children’s daily
activities and knowledge acquisition: A case study among the Baka from
southeastern Cameroon. Journal of Ethnobiology and Ethnomedicine 11,
doi 10.1186/s13002-015-0072-9.
Gaskins, S. (2000). Children’s daily activities in a Mayan village: A culturally
grounded description. Cross-Cultural Research, 34, 375-389.
Greenfield, P; Keller, H; Fuligni, A and Maynard, A. (2003). Cultural
Pathways through universal development. Annual Review of Psycholoy,
54, 461-490.

Grumberg G. and Melià B. (2008). Guarani Retã 2008: Povos Guarani na

Fronteira Argentina, Brasil e Paraguai. Brasilia: CTI.
Harkness, S. and Super, C. (1986). The Developmental Niche: a
conceptualization at the interface of child and culture. International
Journal of Behavioral Development, 9, 545-569.
Hawkes K., O’connell J.F. and Blurton Jones N. (1995). Hazda Children’s
foraging: Juvenile dependency, social arrangements and mobility among
hunter-gatherers. Current Anthropology 36(4), 688-700.
Hunn, E. S. (2002). Evidence for the precocious acquisition of plant
knowledge by Zapotec children. In J.R. Stepp F.S. Wyndham and R.K.
Zarger (Eds.), Ethnobiology and biocultural diversity: Proceedings of the
seventh international congress of Ethnobiology, (pp. 604-613). Athenas;
University of Georgia Press.
Ingold, T. (2000). The Perception of the Environment: essays on livelihood,
dwelling and skill: Routledge. http://dx.doi.org/10.4324/9780203466025.
Instituto Nacional de Estadística y Censos, Argentina, Provincia de Misiones
(n.d.) Encuesta complementaria de pueblos indígenas (ECPI) 2004-2005.
http://www.indec.gov.ar.
Lancy, D. (2008) The Anthropology of Childhood: Cherubs Chattel and
Changelings. Cambridge: Cambridge University Press.
Lancy, D. (2012). The chore curriculum. In G. Spittler, and M. Bourdillion
(Eds.), Working and learning among Africa’s children. Berlin: Lit Verlag.
http://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1570&context
=sswa_facpubs.
Lave, J. (1995). Cognition in practice. Mind, mathematics and culture in
everyday life. New York: Cambridge University Press.
Malinowski, B. (1964). El problema del significado en las lenguas primitivas.
In: C.K.Ogden y L.A.Richards: El significado del Significado. Una
investigación acerca de la influencia del lenguaje sobre el pensamiento y
de la ciencia simbólica (pp 314-324). Barcelona: Paidos básica.
MacDonald, K (2007). Cross-cultural comparison of learning in human
hunting: Implications for life history evolution. Human Nature 18, 386–
402. doi 10.1007/s12110-007-9019-8.
Mignot J.M. (1996). Exemples de techniques d’acquisition de produits
alimentaires mises en oeuvre par les enfants Massa Bugudum. In: de
Garine, A. Froment, Ch. Binam Bikoi, J.-F. Loung (Ed.), Bien manger et
bien vivre. Anthropologie alimentaire et dévéloppement in Afrique
intertropicale: du biologique au social, 425-432. Paris: L’Harmattan.

Miller, D. L. (2007). The seeds of learning: Young children develop important

skills through their gardening activities at a Midwestern early education
program. Applied Environmental Education and Communication, 6 (1),
49-66.
Morelli, C. (2011). Why I used drawings to research Matses children’s shared
understandings in the Peruvian Amazon. Available at: www.methods.
manchester.ac.uk/events/2011-10-05/phd-presentations/morelli.pdf.
Morelli, C. (2013). Teaching in the Rainforest: Exploring Matses Children’s
Affective Engagement and Multisensory Experiences in the Classroom
Environment. Teaching Anthropology, 2(2), 53-65.
Padawer, A. and Enriz, N. (2009). Experiencias formativas en la infancia rural
mbyá-guaraní. Avá 15, 315-330. http://www.scielo.org.ar/pdf/ava/n15/
n15a17.pdf.
Paradise, R. and Rogoff, B. (2009). Side by side: Learning by observing and
pitching in. Ethos, 37, 102–13.
Paradise R. and De Haan M. (2009). Responsibility and Reciprocity: Social
Organization of Mazahua Learning Practices. Anthropology and
Education Quarterly 40(2), 187-204.
Remorini C. (2001). Caminar a través del monte. Una aproximación a la
movilidad Mbya en el pasado y en el presente. Actas de las II Jornadas
sobre Poblamiento, Colonización e Inmigración en Misiones, (pp. 309-
326). Posadas: Ediciones Montoya.
Remorini, C. (2009). Aporte a la Caracterización Etnográfica de los Procesos
de Salud- Enfermedad en las Primeras Etapas del Ciclo Vital, en
Comunidades Mbya-Guaraní de Misiones, República Argentina.
Dissertation, Universidad Nacional de La Plata /Edulp, La Plata.
http://sedici.unlp.edu.ar/bitstream/handle/10915/4293/Documento_comple
to__.pdf?sequence=5.
Remorini, C. (2010). Crecer en movimiento: Abordaje etnográfico de la
crianza y el desarrollo infantil en comunidades Mbya (Argentina). Revista
Latinoamericana de Ciencias Sociales sobre Ninez y Juventud, 8(2), 961-
980.
Remorini, C. (2012). Childrearing and the shaping of children’s emotional
experiences and expressions in two argentinian communities, Global
Studies of Childhood, 2 (2), 144-157. http//: www.wwwords.co.uk/GSCH.
Remorini, C. (2015a). Learning to Inhabit the Forest: Autonomy and
Interdependence of Lives from a Mbya-Guarani Perspective. In: Maricela
Correa-Chávez, Rebeca Mejía-Arauz and Barbara Rogoff. (Ed.), Advances
in Child Development and Behavior. Special issue on Children Learn by

Observing and Contributing to Family and Community Endeavors A

Cultural Paradigm, 49, 273–288. doi:10.1016/bs.acdb.2015.09.003.
Remorini, C. (2015b). El papel de los niños en la obtención, elaboración,
circulación y consumo de alimentos en comunidades Mbya de Argentina.
Anthropology of Food, 9. http://aof.revues.org/7770.
Remorini, C and Rende, M. (2014). Play and Child Development.
Considerations from a Comparative Ethnographic Research in two Rural
Argentinian Communities. The Oriental Anthropologist. A Bi- Annual
International Journal Of The Science Of Man, 14 (2), 241-266.
Remorini, C and Teves, L.(2013). From “Aldea Kue” to the Future: Mbya
Children’s Everyday Life and Perspectives in Changing Contexts. Annual
Meeting of the Anthropology of Children and Youth Interest Group and
Society for Psychological Anthropology. April 4-7, 2013 – San Diego,
California. http://www.aaanet.org/sections/spa/?page_id=931.
Rival, L. (2001). Cerbatanas y lanzas. La significación social de las elecciones
tecnológicas de los Huaorani. In: Descola, Ph and G. Pálsson. (Coord),
Naturaleza y sociedad. Perspectivas antropológicas (pp. 169-191).México
DF: Siglo XXI.
Rogoff, B. (2003). The cultural nature of human development. Oxford: Oxford
University Press.
Rogoff, B. (2014). Learning by Observing and Pitching In to Family and
Community Endeavors: An Orientation, Human Development 57, 69–81.
Rogoff, B., Moore, L, Behnosh, N., Dexter, A., Correa-Chavez, M. and Solís,
J. (2007). Children´s Development of Cultural Repertoires Through
Participation in Everyday Routines and Practices,” In: J.E. Grusec and
P.D. Hastings (eds.), Handbook of Socialization. (pp.490-515). NY:
Guilford.
Rogoff, B., Morelli, G. A and Chavajay, P. (2010). Children’s Integration in
Communities and Segregation From People of Differing Ages.
Perspectives on Psychological Science, 5 (4), 431-440. http://pps.sagepub.
com/content/5/4/431.
Ruddle, K and Chesterfield R. (1977). Education for traditional food
procurement in the Orinoco delta. Berkeley: University of California
Press.
Ruiz-Mallén, I., Morsello, C., Reyes-García, V. and De Faria, R. B. M. (2013).
Children's use of time and traditional ecological learning. A case study in
two Amazonian indigenous societies. Learning and Individual
Differences, 27, 213-222.

Setalaphruk, Ch. and Price, L. L., (2007). Children's traditional ecological

knowledge of wild food resources: A case study in a rural village in
Northeast Thailand. Journal of Ethnobiology and Ethnomedicine, 3 (33).
doi:10.1186/1746-4269-3-33.
Settersten, R. (2002). Proposition and controversies in Life-course
Scholarship. In: Settersten, R (Ed.), Invitation to the Life- course. Towards
new understanding of later life, (pp. 15-48) Amityville, New York:
Baywood Publishing Company.
Taverna, A; Waxman, S.R; Medin, D and Peralta, O. (2012) Core
Folkbiological Concepts: New Evidence from Wichí Children and Adults.
Journal of Cognition and Culture, 12, 325–344.
Toren, C. (1993). Making History: The Significance of Childhood Cognition
for a Comparative Anthropology of Mind. Man 28 (3): 461-478.
Waxman, S., Medin, D. and Ross, N. (2007). Folkbiological reasoning from a
cross-cultural developmental perspective: early essentialist notions are
shaped by cultural beliefs. Developmental Psychology, 43(2), 294.
Weisner, T. (1984). Ecocultural Niches of Middle Childhood. A cross-cultural
perspective. In: Collins, A. (Org.) Development during middle
childhood.(pp.335-369). Washington DC: National Academy Press.
Wyndham, F. S. (2010). Environments of learning: Rarámuri children’s plant
knowledge and experience of schooling, family, and landscapes in the
Sierra Tarahumara, Mexico. Human Ecology, 38(1), 87-99.
Zarger, R. K. (2002). Children’s ethnoecological knowledge: Situated learning
and the cultural transmission of subsistence knowledge and skills among
Q’eqchi’Maya. In J.R. Stepp F.S. Wyndham and R.K. Zarger (Eds.),
Ethnobiology and biocultural diversity: Proceedings of the seventh
international congress of Ethnobiology, (pp. 604-613). Athenas;
University of Georgia Press.
BIOGRAPHICAL SKETCH
1. Name:
CAROLINA REMORINI
2. Affiliation:
Associate Professor- Facultad de Ciencias Naturales y Museo,
Universidad Nacional de La Plata (UNLP) (School of Natural Sciences,
University of La Plata)

Associate Researcher – Consejo Nacional de Investigaciones Científicas y

Técnicas (CONICET) (National Council of Scientific and Technological
Research)
3. Education Background:
Undergraduate Degree
1994-2000. National University of La Plata (Universidad Nacional de La
Plata). School of Natural Science and Museum. (Facultad de Ciencias
Naturales y Museo) (FCNYM, UNLP). Argentine Republic. Major:
Anthropology
Postgraduate Degree
2001-2008. National University of La Plata. School of Natural Science
and Museum. Argentine Republic.
PhD on Natural Sciences. Qualification: 10
Final thesis. Aporte a la Caracterización Etnográfica de los Procesos de
Salud- Enfermedad en las Primeras Etapas del Ciclo Vital, en Comunidades
Mbya-Guarani de Misiones, República Argentina
(Contributions to Ethnographic Characterization of Health-illnesses
Processes on Argentinian Mbya Guarani Communities Life First Stages in
Misiones, Argentine Republic). Facultad de Ciencias Naturales y Museo,
Universidad Nacional de La Plata (Faculty fo Natural Sciences, University of
La Plata)
Available at: (http://sedici.unlp.edu.ar/bitstream/handle/10915/4293/
Documento_completo.pdf?sequence=2)
4. Address:
Av 122 y 60. Edificio Anexo Museo. Laboratorio 112.
Tel: (54-221) 422-8451. Interno 105
B1900FWA La Plata. Argentina
5. Research and Professional Experience:
5.1. Current line of research

Ethnographic and Cross-Cultural Study on Childrearing. Impact on Child
Development and Health in Argentinian Rural and Aboriginal Populations.
Supported by UNLP-CONICET. Since 2009.

5.2. Research positions
- National University of La Plata.

III Level Researcher since 2010
- Consejo Nacional de Investigaciones Científicas y Técnicas (National
Council of Scientific and Technical Research).
Assistant Researcher (2009-2014)
Associate Researcher (since 2014)
5.3. Research Background
2011-2013. Project Director. Atención de la salud materno infantil desde

las perspectivas de la población y del personal sanitario en Molinos, Salta,
Argentina.(Maternal and Childcare Health Services from Population and
Health Staff Perspectives in Molinos. Salta, Argentina) UNLP- Consejo
Interuniversitario Nacional.
2011 -2013. Main Researcher. Vida Doméstica y Articulación Social.
Actividades, recursos y redes sociales emergentes en una población de los
Valles Calchaquíes Septentrionales, Salta (Domestic Life and Social
Brokerage. Activities, resources and social networks emerging in a population
of Northern Calchaqui Valley, Salta). (CONICET. Directed by Marta Crivos.
2001-2005/2006-2009/2010-2013/2014-2016. Main Researcher.
Caracterización Antropológica del modo de vida.Implicancias teórico-
empíricas de las estrategias de investigación etnográfica (Anthropological
Characterization of the Way of Life. Theoretical and Empirical Implications of
Ethnographic Research Strategies). Directed by Marta Crivos and María Rosa
Martínez.
2007-2010. Researcher at International Network. Red Iberoamericana de
Saberes y Prácticas Locales sobre el Entorno Vegetal (RISAPRET)
(Iberoamerican Network for Knowledge and Practices on Vegetal
Environment). CYTED. Iberoamerican Program on Science and Technology
for Development. (Programa Iberoamericano Ciencia y Tecnología para el
Desarrollo Argentina). Directed by Nilda Dora Vignale (Argentina)
5.4. Teaching Background
Current position
Associate Professor since November 2011 Etnografia I Course (South
American and Argentinian Ethnography). Graduate Level. Facultad de

Ciencias Naturales y Museo, UNLP (School of Natural Science and Museum,

National University of La Plata).
Other relevant teaching activity

Graduate seminars and courses:
2012. Tenured Professor and Coordinator. Antropología de la Salud
Seminar (Anthropology of Health). Nursing Undergraduate courses. National
University “Arturo Jauretche.” Buenos Aires. Argentina.
2000-2003/2005-2011. Assistant Professor. Etnografia I Course. (South

American and Argentinian Ethnography). Facultad de Ciencias Naturales y
Museo, UNLP (School of Natural Science and Museum, National University
of La Plata).
Postgraduate seminars:
2012-2013. Tenured Professor. Antropología Cultural y Salud (Cultural
Anthropology and Health). Health Hospital Management Especialization.
University ISALUD. Buenos Aires.
2012-present. Professor. Master Program in Mental Health Applied to
Forensics. (Maestría en Salud Mental Aplicada a lo Forense). Facultad De
Medicina, UNLP. (School of Medicine. UNLP).
2009. Professor. Psychology, Culture and Health. Master in Psychology
and Health. University of Palermo. Buenos Aires.
2009. Visiting Professor Worshop on Methodology of Research. Master in
Culture and Society. Instituto Universitario Nacional del Arte – Área
Transdepartamental de Folklore/Centro Argentino de Etnología Americana –
CONICET.
2008- Visiting Professor in Seminar. "Medicina Tradicional, Salud y
Nutrición Infantil." (Traditional medicine, Health and Nutrition) Red
Iberoamericana De Saberes Y Prácticas Sobre El Entorno Vegetal
(RISAPRET) (Iberoamerican Net for the Knowledge and Practice about the
Vegetal Environment), Programa Iberoamericano Ciencia Y Tecnología Para
El Desarrollo (CYTED) (Iberoamerican Program Science and Technology
towards Development), 11th September 2008, 6 hs. Instituto Nacional de la
Nutrición y Ciencias Médicas "Salvador Zubirán" (INNSZ) (National Institute
of Nutrition and Medical Science). México DF.
2007. Visiting Professor. Seminar. Las contribuciones de la Etnografía
al estudio de las relaciones entre cultura, crianza infantil y procesos
de salud/enfermedad (Ethnography Contributions to the Study of Culture,

Upbringing and Health/illnesses Processes Relationships.). Course:

Psychology, Culture and Health. Master in Psychology and Health. University
of Palermo, Buenos Aires. August.
2007. Visiting Professor. Seminar. La Observación Etnográfica: Aportes
al estudio de las prácticas de crianza y cuidado de la salud. (Ethnographic
Observation: Contribution to the study of Rearing and Health Care Practices).
Master in Culture and Society. Instituto Universitario Nacional de Artes
(IUNA). Área Transdepartamental de Folklore/Centro Argentino de Etnología
Americana – Consejo Nacional de Investigaciones Científicas y Técnicas. 6th
November. Buenos Aires. Argentina
5.5. Non academic professional practice

2009-2006. Professional Advisor. Programa de Mejora de la Atención a
la Comunidad en Hospitales
Públicos de la provincia de Buenos Aires (Improvement Community
Health Care Program at Buenos Aires
Province Public Hospitals). Ministry of Health of the Province of Buenos
Aires. Activities: Interviews, training and technical assistance for health
professionals and administrators.
2007. Professional Advisor. “Updating Courses on Mother–child Care
Programs Management” at Programa Provincial Materno Infantil.(Mother–
child Care Provincial Program). Ministry of Health of the Province of Buenos
Aires. Activities: Design, planning and survaillance of activities. Teacher.
2006. Consultant Advisor. Programa Provincial Materno Infantil.
(Mother–child Care Provincial Program). Ministry of Health of the Province
of Buenos Aires. ARG 00/043 UN Program for Development (PNUD).
2005-2006. Consultant Advisor. Curso de actualización sobre Desarrollo
y Crianza para agentes de Salud de la Provincia de Buenos Aires. (Updating
Seminar on Children Development and Upbringing for Health Workers of the
Province of Buenos Aires).
2005. Consultant Advisor. Uniéndonos por la salud de nuestros pibes (All
Toghether for Children´s Health). UNICEF. Ministry of Health of the Province
of Buenos Aires – Mother-child program.
2005. Workshop Coordinator. Primer Encuentro Provincial de
Promotores Comunitarios de Salud (Health Promoters First Regional
Meeting). Secretariat for Coordination and Health Care. Ministry of Health of
the Province of Buenos Aires.

6. Professional Appointments:
2015 USA. Visiting Professor Fellowship. Brief Stay for Assistant

Researchers financial support. National Council of Scientific and Technical
Research. University of California, Santa Cruz. Psychology Department.
Director. Barbara Rogoff. Title of program: Child Development in Cultural
Contexts: Exploring Theoretical and Methodological complementarities
between Developmental Psychology and Ethnography.
2014- Consejo Nacional de Investigaciones Científicas y Técnicas
(National Council of Scientific and Technical Research) Associate Researcher
2010-2011. University of La Plata: Young Researchers Grant.
2009. Consejo Nacional de Investigaciones Científicas y Técnicas
(National Council of Scientific and Technical Research). Assistant Researcher.
2010 Brazil. Visiting Professor Fellowship. Montevideo Group
Association of Universities Scholarship.
(Asociación de Universidades Grupo Montevideo. Escala Docente). Post
Graduate Program on Social Anthropology. Federal University of San Carlos.
(Universidad Federal de San Carlos). Director: Clarice Cohn.Title of program.
Representations and Practices related to Indigenous Children Upbringing and
Health Care: Tradition and Cultural Change. June 2010.
2008. Mexico. Visiting Researcher Schorlaship. Iberoamerican
Program on Science and Technology for Development. Iberoamerican
Network for Knowledge and Practices on Vegetal Environment. (Programa
Iberoamericano de Ciencia y Tecnología para el Desarrollo) (CYTED). RED
IBEROAMERICANA DE SABERES Y PRÁCTICAS SOBRE EL ENTORNO
VEGETAL (RISAPRET).
Title of program: Childhood Illnesses. Agreement and Disagreement
between Traditional Medicine and Biomedicine. HERBARIO MEDICINAL
DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL (IMSS) – Centro
Médico del Siglo XXI. August-September, 2008.
2006-2007. University of La Plata. Young Researchers Grant.

2001-2003/2003-2006. Postgraduate Scholarship. CONICET. Argentina
2000-2001. Training Program for Advanced Students Scholarship. School
of Natural Science and Museum. UNLP. Argentina
2001. Postgraduate Scholarship. UNLP. Argentina.

7. Honors:
2013. University of La Plata Award to Scientific, Technoogical or Artistic
Work. Young Researcher.
December, 2013. National University of La Plata. Argentina.
2004. Argentinian Association for Science, CONICET (National Council
of Scientific and Technological Research) and Brazilian Society for Science
awards to the paper: “Applied Ethnography Contributions to Health.”
(“Aportes de una Etnografía Aplicada al campo de la Salud”). Authors:
Carolina Remorini and Anahi Sy. Buenos Aires. Argentina.
2004. Annual Award to Innovative Women 2003. Legislature of the
Province of Buenos Aires. Argentina.
2000. Joaquín V. González Award to Outstanding Grade Students.
National University of La Plata. Argentina.
8. Publications Last 3 Years:

Major Publications (since 2012)
-Remorini, C. 2015. Cap. 12. Learning to Inhabit the Forest: Autonomy

and Interdependence of Lives from a Mbya-Guarani Perspective. Advances in
Child Development and Behavior. Special issue on Children Learn by
Observing and Contributing to Family and Community Endeavors A Cultural
Paradigm. Vol 49: 273–288. Eds: Maricela Correa-Chávez, Rebeca Mejía-
Arauz and Barbara Rogoff.
ISBN: 978-0-12-803121-6. doi:10.1016/bs.acdb.2015.09.003
-Remorini, C. 2015. El papel de los niños en la obtención,

elaboración, circulación y consumo de alimentos en comunidades Mbya de
Argentina. (Children´s Role in the Collection, Manufacture, Distribution and
Consumption of Food in Mbya Communities in Argentina). Anthropology
of Food, 9. Dossier: Patrimonios alimentarios infantiles: Iluminaciones
antropológicas, (Children Food Heritage: Anthropological Insights.). Charles-
Édouard de Suremain and Clarice Cohn (organizadores).
ISSN 1609-9168, http://aof.revues.org/7770
-Remorini, C. and Palermo, M. L. 2015. Salud materno-infantil y politicas

públicas para Pueblos Originarios. Reflexiones a partir de una investigación
etnográfica. (Maternal-Child Health and Public Policies for Indigenous
Peoples. Reflections from an Ethnographic Research). In: Marina Cardoso and
Esther Jean Langdon (Eds.) Políticas comparadas en Saúde, Indigena na

América Latina. Published by Universidad Federal de Sao Carlos. pp247-278.

ISBN 978-85-328-0735-9.
-Remorini, C and M. Rende. 2014. Play and Child Development.

Considerations from a Comparative Ethnographic Research in two Rural
Argentinian Communities. The Oriental Anthropologist. A Bi- Annual
International Journal Of The Science Of Man. Vol. 14, No. 2, 2014, 241-266.
MD Publications Pvt Ltd. New Delhi. ISSN: 0972-558X.
-Remorini, C. 2014. Los estudios etnográficos sobre el desarrollo infantil

comunidades indígenas de América Latina: contribuciones, omisiones y
desafíos. (Ethnographic Studies about Child Development in Latin American
Indigenous Communities: Contributions, Omissions and Challenges). Revista
Perspectiva de la Universidade Federal de Santa Catarina (UFSC), Dossier:
Escolarização e Infância na América Latina: Perspectivas Etnológicas. Ademir
Valdir dos Santos (organizador). Vol 31 (3): 810-840. 2013. ISSN print 0102-
5473, ISSN 2175-795X https://periodicos.ufsc.br/index.php/perspectiva/issue/
view/2094/showToc
-Remorini, C. 2013. Estudio etnográfico de la crianza y la participación

infantil en comunidades rurales de los Valles Calchaquíes Septentrionales,
Noroeste Argentino. Resultados preliminares. (Ethnographic Study of
Childrearing and Child Participation in Rural Communities of Northern
Calchaqui Valleys, Northwest Argentina. Preliminary Results). Boletín del
Instituto Francés de Estudios Andinos (BIFEA), 42 (3): 411-433. Dossier.
“Infancia y niños en los Andes, ayer y hoy.” Palmira La Riva
González, Charles Edouard De Suremain and Robin Cavagnoud (Org).
http://www.ifeanet. org/publicaciones/detvol.php?codigo=536.
-Crivos, M, Martínez M.R., Remorini, C. and Teves, L. 2012. Changing

Life Strategies. Mbya People and Their Relationship with Tourism. In: Jeffrey
L. Roberg and Penny Seymoure (Eds). Tourism in Northeastern Argentina.
The Intersection of Human and Indigenous Rights with the Environment,
Lexintong Books, UK. pp. 45 a 57. ISBN 978-0-7391-3778-9. ISBN 978-0-
7391-3780-2 (electronic)
-Crivos, M, M. R. Martínez, C. Remorini and A. Sy. 2012. Some

Considerations Regarding the Origin and Functions of Parasites among Two
Mbya Communities in Misiones, Argentina. In: Brenda Gardenour and Misha

Tadd (Eds.): Parasites, Worms, and the Human Body in Religion and Culture.
Peter Lang Publishing, New York, USA. Pp. 95 a 121. ISBN 978-1-4331-
1547-9. ISBN 978-1-4539-0263-9 (e-book)
-Remorini, C. 2012. Mbya Grandmothers, Mothers and Granddaughters.

In: Ruth C. White (Ed.): Global Case Studies in Maternal and Child Health.
Jones and Barlet Learning, Burlingtong, MA, USA. Pp. 231-256. ISBN 978-0-
7637-8153-8 (pbk.).
-Remorini, C. 2012. Childrearing and the shaping of children’s emotional

experiences and expressions in two Argentinian communities. Global Studies
of Childhood 2 (2):144-157. Special issue on emotion socialization. ISSN
2043-6106. http://www.wwwords.co.uk/gsch/.
-Remorini, C; M. Crivos, MR.Martínez, A. Aguilar Contreras, A. Jacob

and ML Palermo. 2012. Aporte al estudio interdisciplinario y transcultural del
‘Susto.’ Una comparación entre comunidades rurales de Argentina y México
(Contribution to the Interdisciplinary and Crosscultural Study of “Susto.” A
comparison between Mexico and Argentina) Dimensión Antropológica
(CONACULTA_INAH, México) Año 19, vol.54. Enero-abril de 2012. Pp. 89-
16. ISSN 1405-776X.
-Remorini, C. (in submission) Salud en Movimiento. Modo de vida,

estrategias locales frente a la enfermedad y servicios de salud para el Pueblo
Mbya Guarani (Misiones). (Health in Motion. Way of Life, local strategies
before illnesses and health care for Mbya Guarani People, Misiones). In: Silvia
Hirsch and Cristina Fontes (Comp.): Salud pública y pueblos indígenas en la
Argentina: encuentros, tensiones e interculturalidad. (Public Health and
Indigenous Peoples in Argentina: encounters, tensions and interculturalism).
Conference Papers
-Remorini, Carolina. 2015. Children's development in the context of their

participation in subsistence activities in rural communities of Northwest
Argentina. Society for Psychological Anthropology's Biennial Conference.
Session “Constructions of Caretakers and Children.” Chair: Bambi Chapin.
Boston, MA. 9 al 12 de abril de 2015

-Remorini, C. 2014. Learning from babies. The productivity of

observation in the ethnographic characterization of a way of life. Panel:
Learning from/with children: anthropologist at "school" (Commission on
Children, Youth and Childhood). Convenors: Jean Paul Filiod (Université
Claude Bernard Lyon 1), Kae Amo (EHESS) and Takao Shimizu (Research
Institute for Humanity and Nature). IUAES Inter- Congress 2014. Chiba,
mayo de 2014. http://www.nomadit.co.uk/iuaes/iuaes2014/panels.php5?
PanelID=2901
-Remorini, C and Palermo, ML- 2014. On “children at risk” and “not good
enough parents.”
Conceptualizations about childhood, children and their families as an
object of health policies in Molinos
(Salta, Argentina). Bienal Latinoamericana de Infancias y Juventudes
Session: Construcciones diversas de niñez, crianza y aprendizaje en América
Latina y su lugar en las políticas públicas de educación y salud.
Colombia, Manizales, 17-21 November 2014. http://bienal-clacso-redinju-
umz.cinde.org.co/
- Remorini, C and L. Teves. 2013. From “Aldea Kue” to the Future:

Mbya Children’s Everyday Life and Perspectives in Changing Contexts.
Annual Meeting of the Anthropology of Children and Youth Interest Group
and Society for Psychological Anthropology. April 4-7, 2013 – San Diego,
California. Panel: Indigenous Children, Identities and Processes of Change in
Contemporary Latin America. http://www.aaanet.org/sections/ spa/?page_
id=931
- Remorini, C. 2012. Becoming a person from Mbya Guarani perspective

(Misiones Province, Argentina). Anual Meeting of the Society for Cross-
Cultural Research. AAACYIG. American Anthropological Association's.
Children and Childhood Interest Group. 22nd-25th February 2012. Las Vegas,
USA. ACYIG. Symposium: The Cultural Construction of Identity: How
Children Become Persons?. Panel Organizer: David Lancy. Abstract published
pp 64.
- Remorini, C. 2012. Salud materno-infantil y políticas públicas para

Pueblos Originarios. Reflexiones a partir de una investigación etnográfica.
(Maternal-Child Health and Public Policies for Indigenous Peoples.
Reflections from an Ethnographic Research) 28 Reunión Brasilera de

Antropología. Symposium Políticas Comparadas em Saúde Indígena na

América Latina. Convenors: Esther Langdon and Marina Cardoso. San Pablo,
July 2 -5, 2012.
- Remorini, C. 2012. El papel de los niños en la obtención, elaboración,

circulación y consumo de alimentos en comunidades Mbya Guarani de
Argentina. (Children´s Role in the Collection, Manufacture, Distribution and
Consumption of Food in Mbya Guarani Communities from Argentina)
Symposium 855
- Children's food heritage. Anthropological issues. Convenors: Charles-

Édouard de Suremain and Clarice Cohn. Proceeding (CD-ROM). 54 ICA.
International Congress of Americanists. “Building Dialogues in the
Americas.” Viena, July 15-20, 2012. http://ica2012.univie.ac.at/ index.php?
id=117155&no_cache=1&L=12&tx_univietablebrowser_pi1[backpid]=11715
4&tx_univietablebrowser_pi1[fkey]=855
- Remorini, C and ML Palermo. 2012. “… Es que antes no sabía haber

doctor.” Alternativas para el cuidado de la salud materno-infantil en una
población de los Valles Calchaquíes (Salta, Argentina). (“…We used to have
no doctor.” Alternatives for Maternal-Child Health Care in a Village of the
Calchaqui Valleys (Salta, Argentina). Symposium 757 - Ofertas terapéuticas y
cuidados de la salud en contextos interculturales. (Therapeutical Offers and
Health Care in Crosscultural Contexts). Convenors: Idoyaga Molina, Anatilde
and Marta Crivos. Proceeding (CD-ROM). 54 ICA. International Congress of
Americanists. “Building Dialogues in the Americas.” Viena, July 15-20, 2012.
http://ica2012.univie.ac.at/index.php?id=117155&no_cache=1&L=12&tx_uni
vietablebrowser_pi1[backpid]=117154&tx_univietablebrowser_pi1
[fkey]=757
- Remorini, 2012. The Role of Ethnography in Latin American

Studies about Child Development: Challenges, Intersections and Disputes-
Inter-Congress of the IUAES Commission on Children, Youth And
Childhood, Panel: Studies of Children and Childhoods in Latin America from
the Colonial Period to the Present. Panel Organizer: Nadia Marín-Guadarrama.
Bhubaneswar, India, November 26-30, 2012. http://www.kiit.ac.in/ iuaes/
index.html

- Remorini, C and M. Rende. 2012. Play and Child Development. Some

Considerations from an Ethnographic Research in Two Rural Argentinean
Communities- Inter-Congress of the IUAES Commission on Children, Youth
And Childhood, Panel: Research on Children's Play and Toys in Non-Western
or Non-Industrial Communities and its Contribution to Anthropology and
Ethnology. Panel Organizer: Deeksha Nagar. Bhubaneswar, India, November
26-30, 2012. http://www.kiit.ac.in/iuaes/index.html

Chapter 3
TRADITION AND TRANSFORMATION OF

EASTERN JAMES BAY EEYOU (CREE)
FOODWAYS IN PREGNANCY:
IMPLICATIONS FOR HEALTH CARE
Helen Vallianatos and Noreen Willows *
University of Alberta, Edmonton, Alberta, Canada
ABSTRACT
Many Eeyou (Cree) women living in the James Bay region of
Quebec experience excess weight gain in pregnancy, and retain weight
between pregnancies, contributing to obesity related health problems.
Health practitioners might be better able to advise Eeyou women on
healthy diets and physical activity if conversant with Eeyou history and
traditions. We provide a picture of mid-20th century lifestyle practices of
Eeyou women when pregnant and breastfeeding with the aim to
provide information that could potentially be used to improve culturally
competent prenatal and postnatal care for Eeyou women. The research
consisted of (1) a literature review that documented how Eeyou lifeways
have changed as a result of European colonization, and (2) qualitative
interviews with ten Eeyou Elders who had borne their children at a time
when people still lived in the bush. The literature review and thematic
analysis of Elder interviews showed that colonization by Europeans led to
*
Corresponding Author’s Email: noreen.willows@ualberta.ca.

72 Helen Vallianatos and Noreen Willows
profound changes in the lifeways of Eeyou women, through the rapid

transformations of cultural traditions, physical activity patterns and
foodways. Still, even today the “bush” is seen as a healing place. Elders
had concerns about changing foodways, as traditional Eeyou food
acquired from hunting, fishing and gathering is considered as vital for a
sense of Eeyou identity. Elders focused on the shift away from a
traditional subsistence life as the reason why so many women faced
weight challenges. Elders’ perceptions of appropriate quantities and types
of food that women should consume were apt for a time when people
lived a physically active life in the ‘bush,’ different from contemporary,
sedentary lifestyles experienced by many women. Thus, not all advice
provided by Elders would be appropriate in today’s food environment.
The information we provide could help frame health advice for
contemporary Eeyou women in their reproductive years. Based on the
cultural importance and nutritional significance of Eeyou food, a strategy
to promote wellness among Eeyou women might be the consumption of
traditional food in combination with healthy Western foods. Furthermore,
bush spaces such as hunting camps might be culturally appropriate
healing spaces to hold prenatal and postnatal programs. Health promotion
strategies must be respectful of the fact that not all women will like
Eeyou food, have time to prepare it, or consider eating it as integral to
their sense of identity. Women must decide for themselves what their
particular worldview will encompass about Eeyou traditions and
modernity in the 21st century.
INTRODUCTION
One legacy of European colonialism among indigenous1 peoples in
Canada and the United States is striking dietary and activity changes as
people transitioned from their indigenous lifestyles to a Western lifestyle. This
transition resulted in a profound increase in obesity and the prevalence of
diabetes in indigenous populations (Dyck et al. 2010; Garriguet 2008;
Ravussin et al. 1994; Willows, Hanley and Delormier 2012). The Canadian
and American literature on the reasons for the current diabetes ‘epidemic’
among First Nations peoples and Native American Indians often takes a
1
Indigenous peoples are the descendants of those who inhabited a geographical region at the time
when people of different cultures or ethnic origins arrived. The colonizers became dominant
through conquest, occupation, settlement or other means. The indigenous peoples of Canada
and the United States include Alaska Natives, American Indians, First Nations, Métis, and
Inuit. They practice unique traditions that make them distinct from the dominant society in
which they live (http://www.un.org/esa/socdev/unpfii/documents/5session_factsheet1.pdf).

Tradition and Transformation of Eastern James Bay Eeyou (Cree) … 73
strictly scientific biomedical perspective to explain why the disease exists

(e.g., Bruce et al. 2011; Hanson et al. 2013; Tullock-Reid et al. 2003;
Wheelock et al. 2016). While biomedical explanations help researchers to
understand the elevated prevalence of diabetes in indigenous populations, a
purely biomedical focus fails to take into account the historical, social and
cultural reasons for the emergence of obesity and diabetes (Loutitt 2005; Rock
2003; Willows, Hanley and Delormier 2012). Understanding indigenous
cultures’ historical, socio-economic, cultural, and contemporary milieu of
community living could substantially augment health care professionals’
understanding of disease patterns in indigenous populations, and how to
remedy them (Loutitt 2005; Willows, Hanley and Delormier 2012).
Many pregnant First Nations women develop gestational diabetes mellitus
as a complication of obesity. Fetal complications of gestational diabetes
include operative delivery, macrosomia, intrauterine death, and admission to
the neonatal intensive care unit (Dyck et al. 2010; Liu et al. 2012; Oster et al.
2014; Willows, Sanou and Bell 2011). Research indicates that for First
Nations and American Indian women the breakdown in transmission of
cultural wisdom about health-promoting indigenous lifestyle practices, in part,
has contributed to some of the health problems that women experience in
pregnancy and in the postnatal period (Long and Curry 1998; Vallianatos et al.
2006, 2008). Yet, First Nations women who require intensive prenatal and
postnatal care, and nutrition and lifestyle counseling, often only receive
guidance from Western health providers despite living in two different worlds
– Western and Traditional. The provision of high quality, culturally competent
care for these women requires health care providers to have knowledge of the
following elements: (1) how European colonization accounts for health
disparities and health inequities among indigenous peoples, (2) recognizing
socio-cultural factors that are health-protective, as well as those factors which
undermine the health of indigenous peoples and place them at risk for
increased morbidity and mortality, and, (3) knowing how to acknowledge and
value indigenous knowledge with respect to the health and wellness of
indigenous clients, families, and communities (Hart-Wasekeesikaw 2009). A
better understanding of these elements could be gained from traditional
cultural wisdom provided by First Nations Elders2 (Long and Curry 1998;
Tarlier and Browne 2011; Tarlier et al. 2013).
2
In a Canadian indigenous context, the term ‘elder’ can refer to a person younger than sixty-five
years of age, which is Canada’s usual age cut-off for seniors in the general population.
‘Elder’ is capitalized when it is used to describe an older indigenous person who is a

The Eeyou3 (Cree) First Nations living in the James Bay Region of the
province of Quebec have retained aspects of their traditional hunting culture
despite European colonial efforts at assimilation. Even after several hundred
years of exposure to European languages, the Eeyou language is still spoken
along with English or French in almost every sphere of community life
(Louttit 2005). Eeyouch are asserting themselves to address obesity, diabetes,
and other health challenges in their communities. The provision of high
quality, culturally competent care in the region requires health care providers
to understand the history and impact of colonization on Eeyou lifestyle
practices, as well as the cultural, emotional, and spiritual aspects of Eeyou
beliefs about health and healthcare (Dobbelsteyn 2006).
The purpose of this paper is to provide information that could be used to
improve culturally competent prenatal and postnatal care for Eeyou women by
providing insight on historical changes affecting dietary practices specific to
women’s reproductive years. Information to inform culturally appropriate
programs that promote the consumption of traditional Eeyou food while
simultaneously reducing the consumption of energy-dense and nutrient-poor
market foods was gained from an overview of the literature on colonization,
and from interviews in 2004 with female Eeyou Elders. This work builds upon
our previous efforts to understand meanings of food, body size and health
among Eeyou women during their reproductive years (Vallianatos et al. 2006,
2008) by presenting additional analysis of interviews conducted with Elders
who embodied and symbolized an enduring legacy of the Eeyou language,
food traditions, lifestyle practices, and hunting culture that are the foundation
of ancient Eeyou history (Louttit 2005). The Cree Board of Health and Social
Services of James Bay (Quebec) provides health and social services to the nine
communities of the Cree Territory of James Bay. It supported this research in
light of concerns on the health ramifications of excessive prenatal and
postnatal weight, and weight gain in pregnancy, in the region.
cultural or spiritual guide (Dumont-Smith, 2002, www.ahf.ca/downloads/

ahfresearchelderabuse_eng.pdf)
3
Cree is the colonial term used in the academic literature to describe some First Nations people
living in northern Quebec and elsewhere. The First Nations people of northern Quebec call
themselves Eeyouch (plural) or Eeyou (singular). Where possible, Eeyou and Eeyouch are
used in this paper, in place of Cree.

LITERATURE REVIEW OF EUROPEAN COLONIZATION IN

EEYOU ISTCHEE
The ancestral territory of the Eeyou people is known as Eeyou Istchee. It is
located on the southeastern side of Hudson’s Bay and the eastern part of James
Bay. The nine Eeyou communities in the territory are categorized as coastal or
inland depending on their proximity to coastal waters (Figure 1). Eeyouch first
had significant contact with European fur-traders in 1668. In the 150 years that
followed, they were active participants in the fur trade (Francis and Morantz
1983). Up to the 1950s, except for certain families who lived year-round in
coastal settlements, Eeyouch moved around on a seasonal basis throughout
their hunting territories, gathering at fur trading posts in the warm weather
months (Torrie et al. 2005a). Lifeways thus initially continued with little
change from precontact patterns, both in terms of Eeyou economic and
political autonomy and subsistence and settlement practices (Morantz 1983;
2002). Midwives, leaders, healers and other knowledgeable Eeyou assumed
responsibility for childbirth and for the prevention of illness (Torrie et al.
2005b). Eeyouch ate Eeyou meechum (Cree food), which is wild animal food
procured from land, water or sky: mammals such as caribou, seal, beluga,
bear, moose, beaver, hare; fish such as trout, pike, whitefish and sturgeon; and,
birds such as geese, duck, ptarmigan, and grouse. This animal-based diet was
supplemented by berries when in season (Adelson 2000; Flannery 1995;
Preston 1981). Periods of hunger were common, as food could not be stored
for long periods and food animals cycled in number and availability—a pattern
also experienced in other northern First Nations communities (Flannery 1995;
Preston 1981).
Although waamishtikushiiumiichim (“white man’s” food)—which
originally was flour, sugar, baking powder, oats, lard and tea—became more
common in conjunction with missionary activities initiated in the region in
1852 and state colonialism, these foods initially did not constitute a significant
part of the diet (Feit 2004; Morantz 2002). Traditional subsistence activities
continued well into the early part of the 20th century, with wild foods
providing 25-55% of energy requirements and half the required nutrients (Feit
2004).

Figure 1. Map of Eastern James Bay, with the nine contemporary Eeyou (Cree)
communities, used with permission from the Cree Board of Health and Social Services
of James Bay.

In 1930 the first European medical establishment in Eeyou Istchee

was established, starting the trend of having non-indigenous health care
professionals, especially nurses, assuming responsibility for curative care
(Torrie et al. 2005b). Following World War II a federal government
programme of preventative and curative health services was initiated in
parallel with free housing, local schooling, sanitation, nutrition, income
assistance and pensions (Torrie et al. 2005b). From about 1930 and continuing
through the 1960s, mandatory school attendance for children and the
increasing availability of social benefits such as welfare, housing, and medical
care in the communities led people to settle in the communities (Torrie et al.
2005a). Permanent settlement was further encouraged by the advent of roads,
electric and phone lines, and the establishment of wage employment and local
day schools, so that alterations in traditional activity patterns and diets became
more pronounced (Feit 2004; Morantz 2002; Preston 1981, 2002).
Concomitant with these impositions, “white man’s” foods became increasingly
entrenched as dietary staples.
State exploitation of natural resources in Eeyou Istchee, most
dramatically evidenced with the advent of the James Bay hydroelectric
project in 1971, resulted in the first ‘modern’ treaty in Canada: the James
Bay and Northern Quebec Agreement (1975). In return for the hydroelectric
development, a formal land-claim settlement was instituted and schools and
basic infrastructure (i.e., electricity, water, and sewage) were built or
expanded. However, other problems developed or worsened, including wage
labour unemployment, substance abuse, fear of eating local fish due to public
health concerns about mercury contamination, and further diminishment of
traditional subsistence patterns and other customs (Adelson 2000; Berkes and
Farkas, 1978; Feit 2004; Kirmayer et al. 2000; Niezen 1993, 1997, 1998).
Contemporary Eeyouch are predominantly engaged in the wage economy
and consume mostly market food. Eeyou meechum is not regularly procured
due to time or skill limitations, concerns about contaminants in food (e.g.,
mercury in fish), species decline due to logging in surrounding regions, and
overhunting and overfishing (Berkes and Farkas, 1978; Vallianatos et al. 2006;
Willows 2005). Although Eeyou meechum is diminished in the contemporary
diet from historic proportions, hunting and to a lesser extent trapping activities
have been resilient in the face of 20th-century transformations that threatened
to be devastating in their impact on traditional land-based culture and
economy (Feit 2004; George, Berkes and Preston 1995). Eeyou meechum
obtained from traditional subsistence activities continues to be highly valued,
demonstrated in its contemporary role in gift exchange (Adelson 2000; Feit

2004). Many Eeyou adults and youth believe that Eeyou meechum is good
because it is both nutritious and fosters a sense of Eeyou identity (Adelson
2000; Louttit 2005). Eating Eeyou food is not merely a physical act that
nourishes the body but simultaneously integrates and sustains Eeyou hunting
traditions within contemporary Eeyou society (Louttit 2005). Additionally,
Eeyou meechum is considered by many Eeyou to be ‘stronger’ than
waamishtikushiiumiichim (Adelson 2000; Louttit 2005). Thus, even in the 21st
century most individuals in Eeyou Istchee consume traditional food obtained
from the pursuit of gathering, fishing, or hunting at least occasionally.
There are generational differences in traditional food consumption
with children less likely to eat Eeyou meechum than adults, and younger
adults less likely to eat Eeyou meechum than Elders (Bobet 2013; Johnson-
Down and Egeland 2012; Nieboer et al. 2013). These generational differences
in traditional food consumption are partly due to varying taste preferences. A
more crucial reason is generational distinctions about what it means to be
Eeyou and whether consuming Eeyou meechum as an embodiment of Eeyou
culture is required to achieve a sense of Eeyou identity. One study completed
in the early 2000s found that a majority of Eeyou youth in one community felt
that it made no difference to their sense of Eeyou identity if they chose to eat
non-Eeyou food, even while they recognized the cultural significance of Eeyou
meechum, as summarized by these statements, “The food is not the only thing
to identify me.” (Louttit 2005, 62) and “But it’s not the food that makes me
Cree.” (Louttit 2005, 63).
Due to its high nutrient density, traditional Eeyou food consumed in even
small quantities positively contributes to the nutritional status of Eeyouch
(Downs et al. 2009; Johnson-Down and Egeland 2012). The market food
substitutes for Eeyou meechum can be expensive to purchase and are often
processed foods that are high in fat and sugar, and of low nutritional value
(Willows 2005; Willows et al. 2005). Eating these poor quality market foods
likely contributes to the development of diabetes in the communities (Johnson-
Down et al. 2015). Whereas the energetic traditional lifestyle of the past meant
that obesity was rare, sedentary lifestyle practices coupled with a changed diet
now promote obesity. The majority of pregnancies in Eeyou Istchee are
complicated by obesity and almost half of all women gain excessive weight
during their pregnancies. Consequently, many pregnant women develop
gestational diabetes mellitus (GDM) and consequently about one-third of
newborns have an excessively high birth weight (i.e., over 4000 grams)
(Willows et al. 2011).

Larger body size and fat in food or on the body have different meanings in
different cultural contexts (e.g., Popenoe 2004; Ulijaszek and Lofink 2006).
For Eeyou adults interviewed around 1988, having excess fat on one’s body
was a sign of well-being, not a harbinger of future ailments (Adelson 2000)
given that oral histories recount severe episodes of hunger and infectious
disease epidemics in the region (Flannery 1995; Louttit 2005; Morantz 2002;
Preston 2002). Studies done 10 to 15 years later with Eeyou youth suggest
generational differences in accepting larger body sizes. For Eeyou youth who
had high exposure to Western media that portrayed non-indigenous valuations
of the positive attributes of thinness, poor body image emanating from
excessive weight was a concern (Louttit 2005; Willows et al. 2013). In
addition, youth who associated excess weight with diabetes were more likely
to consider their body size to be too big (Louttit 2005; Willows et al. 2009).
Eeyou adults interviewed in the 1970s, 1980s and 1990s considered
consuming fat and fatty meat from goose, bear, and beaver or fatty fish to be
part of a healthy lifestyle given that animal fat was historically a vital source
of energy and had an eminent place in the traditional diet (Adelson 2000;
Boston et al. 1997; Preston 1981). However, in the past, unlike today, fatty
foods were difficult to acquire considering the leanness of most game meat
and fish. Although this valuing of fat is a cause for concern from a biomedical
standpoint because of the high number of calories it contains, fat from fish and
game is less saturated and more heart healthy than the fat from domesticated
animals (Belinsky and Kuhnlein 2000; Belinsky et al.1996; Dewailly et al.
2002). Nutritionists consider the types of fat present in wild game, fowl and
fish to be desirable and encourage their consumption, in contrast to the
unhealthy fats found in processed market foods (Belinsky and Kuhnlein 2000;
Belinsky et al. 1996; Dewailly et al. 2002). A food guide created in 2007 by
the Federal Government of Canada that reflects the values, traditions and food
choices of First Nations, Inuit and Métis peoples, promotes traditional
indigenous foods and the moderate consumption of indigenous fats
(http://www.hc-sc.gc.ca/fn-an/pubs/fnim-pnim/index-eng.php). Given the
recognition of obesity-related diseases and the importance of fat in traditional
foodways, public health efforts in Eeyou Istchee encourage people to reduce
fat in the diet from processed foods, not wild foods. However, confusion
inevitably arises about whether fat from wild food is healthy given negative
messaging about fat in market food. A study reported an Eeyou youth
commenting that traditional food was not always good to eat because, “There
is a lot of grease on the animals. If you eat too much traditional foods you can
get diabetes.” (Louttit 2005, 61).

INTERVIEWS WITH FEMALE EEYOU ELDERS

Participants
We analysed transcripts from semi-structured interviews conducted in

2004 with ten female Eeyou Elders who had borne children from the 1950s
to the 1970s. All Elders had predominantly lived in the bush during their
reproductive years; consequently, traditional Eeyou meechum was relied
upon and physical activity was a necessity of life (as opposed to today, where
technological advancements such as snowmobiles and generators have
made bush life less arduous) (Vallianatos et al. 2008). The contemporary
(circa 2016) food environment of the communities where Elders lived
has experienced little change since the time of the interviews in 2004, with
prepared, processed, and “junk” foods being readily accessible. Local
restaurants serve fast foods such as French fries, hamburgers, fried battered
chicken, pizza and poutine (i.e., French fries, a gravy-like sauce, and cheese
curds). Fried chicken, including chicken nuggets, and French fries are sold
ready-to-serve in local grocery stores. Some residents prepare meals
(traditional Eeyou meals such as roasted Canadian goose (Branta canadensis)
as well as more exotic fare such as “Chinese”) to be sold as take-out from their
homes, and set up fast food canteens and snack stands in their homes to make
money. From the time of the interviews with Elders until today retail food
prices in the communities are higher than in other areas of the Province
(Duquette, Scatliff and Choquette 2013).
Interviews queried woman about their recollections of weight gains
(and losses) during their reproductive years and their perspectives on the
reasons for the weight challenges faced by so many young contemporary
women (cf. Vallianatos et al. 2008). The interview questions were developed
with a local clinician working in Eeyou Istchee and two Community Health
Representatives who were community members trained to provide and
promote health care education. An Eeyou speaking Community Health
Representative was present at all interviews which were conducted in the
Eeyou language or in English, as the participant chose. The Community Health
Representative translated questions and responses from the Eeyou language
into English and vice versa. All women gave informed consent to participate
in the interviews. The Human Research Ethics Board of the Faculty of
Agriculture, Forestry and Home Economics at the University of Alberta
approved the study (project number 04-15).

Data Analysis
Transcripts underwent content analysis, meaning that they were examined

for thematic patterns that emerged from the Elder’s voices (DeVault 1990).
First, interview data were reviewed line-by-line to analyze the main concepts,
and these concepts were given codes. Second, the codes were compared to one
another to see how they might be related. They were then organized into
thematic categories. Finally, overarching themes were developed through a
comparative analysis of the categories and by comparing them to research
published in academic sources. An important aspect of trustworthiness of
qualitative research is that interpretation be not only from the perspective of
academics, but also from the participant communities (Harrison, MacGibbon
and Morton 2001). Thus, staff from the Cree Board of Health and Social
Services of James Bay (Quebec) reviewed drafts of this manuscript for cultural
appropriateness and congruency with Eeyou culture and language.
Resulting Themes from Interviews
Modern Circumstances Lead Many Young Women to Eat a Lot of

Processed Foods
Elders recalled spending much of their reproductive lives procuring and
preparing traditional foods, and rarely consuming any kind of technologically
processed foods. In their youth they had learned to prepare and cook
introduced “White man’s” produce that was unfamiliar. Elder [M6] recalled
that approximately 25 years before the interview (i.e., about 1979) “when we
started introducing vegetables in the diet we used to have the support group of
women, and what we did is we would take one vegetable, like turnip, and cook
it in four or five different ways, and get people to taste it, and then give the
recipes, and we would invite men and children to eat whatever was cooked.”
Life in permanent settlements has made processed, store-bought foods more
available and traditional foods less accessible. In contrast to the whole foods
(both market and traditional foods) that they consumed during their
reproductive years, Elders witnessed their children and grandchildren eating
pizza, hamburgers, French fries, poutine, and frozen meals, and snacking on
soda pop, potato chips and chocolate. The Elders concurred that young
mothers have different taste preferences than when they were young. In the
words of Elder [W5]: “But the thing I find too is that they really love to buy
stuff that’s already cooked; like say, you throw in the microwave, that type of

thing, you know.” Elder [W3] noted the correlation between changing patterns
of food consumption and body size, “I think right now, women are gaining
more weight these days, not like the old days in the 1960s, before the 1960s,
[when] the ladies didn’t weigh too much. … I think the change [in availability]
of restaurants, and [eating] a lot of pastry food; and like the restaurants, we
go there often.” Some Elders, such as M6 were sympathetic to the time
constraints experienced by women that led them to eat prepared and
convenience foods:
A lot more women are working [i.e., paid employment] so they don’t
have as much time to cook, so they eat a lot more prepared foods, that’s
what we notice. And oftentimes many women cook, I mean, people put
food on the table but they’re not actually cooking, it’s a lot of prepared
foods. And that’s it. There has to be, you know, a juggling between, even
though life we say is kind of slow [here], basically it isn’t really slow-
paced here, people have a job and they pick up their kids from day care,
go home, prepare the supper, in the evening there’s something else; and
it’s pretty much the life that you have in the city now.
Thus, Elders understood that the pace of life had changed, and women
who face the “doubleshift” (i.e., employed outside the home but continue to
have primary domestic responsibilities) may often resort to feeding prepared
foods to their families.
Elder M6 also identified the constant availability of food as leading to
excessive intake: “in the past there were feasts but there were long periods of
fasting, and now it’s like repeated feasts, but there’s no more fasting in
between.” Considering the history of famines in the region with forced periods
of fasting, the constant availability of food today is a blessing. Yet, as the
Elder identified, without intermittent periods of low food intake or dietary
moderation, and as mentioned by other Elders, when “feasting” is frequent,
weight gain may follow and potentially lead to the health problems that affect
Eeyouch today.
Elders identified a lack of time, culinary skills and male kin who hunt, fish
or trap as constraints to the preparation of traditional foods. In addition,
community members no longer share traditional food as in the past, limiting its
availability. Elder [W5] stated: “The thing is, the access, you can’t really get
traditional food, it’s not as available as we would like to see it, because there
are some people who do hunt and then they put their moose meat in the
freezer, you know, because they have to keep it for their family, you know.

There are odd times when they have [ceremonial] feasts, they’ll donate some
food.”
Pregnant Women Need to Eat in Moderation and Be Active

Infant birth size was understood traditionally to be influenced through
maternal diet and physical activity patterns. Maintaining physical activity in
pregnancy through active living was important, as 70 year old Elder [M4],
recalled,
we were told when we were young it’s not good for a pregnant
woman to sit around and not be active because the delivery will be very
difficult if you tend to sit around most of the time. During the time that I
had babies women my age were very active and did many activities. …
they did many things around the home, getting wood, splitting [wood],
just had to be careful not to overdo it. In our days, women were
encouraged to keep moving ‘till the very end of their pregnancy so the
delivery would be easier for them because it was not good for them to
stay quiet.
Elders emphasized that having a moderate-sized baby—considered to be

healthy—was desirable for birthing with relative ease, and decreasing the
likelihood of maternal and infant health complications. Avoiding “big and
lazy” babies was a common reason mentioned by Elders as to why pregnant
women should eat in moderation. Traditionally, labour and birth was viewed
as a process requiring the cooperation of mother and infant. Larger-sized
infants were more likely to be “lazy” and uncooperative during labour, thereby
making labour and birth more difficult or even dangerous. The words of Elder
[W4] emphasize the perceived interaction between maternal and infant
behaviour:
You don’t just lie around, or just eat and lie around. … taking a walk
or even work, like labor work, that’s what we used to be told by our
parents you know. You don’t just lie around just because you’re pregnant,
you know, you have to do physical things. If you do physical things, your
delivery will be easy. Your baby won’t be lazy. If you just lie around then
when you start your labour pains and the baby’s trying to get out, he’s
gonna be lazy to come out.
Eating in moderation and reducing portion sizes was advice Elders

emphasized for pregnant women. Elders also recognized the importance of

limiting fat consumption in pregnancy to prevent excess harmful weight gain.

Elder [W1], in her seventies, recalled in pregnancy being “careful with
whatever I ate, that it wouldn’t be too greasy or contain too much fat, because
I was afraid that the baby would grow too big and I would have problems
when I delivered.”
Breastfeeding Can Help Women with Weight Loss

Elder [W1] recalled how following pregnancy “I didn’t have to watch
what I ate, like I ate whatever I wanted to, but breastfeeding helps a lot
because it helps a woman keep her shape and not gain too much weight. I had
seven children altogether, and I breastfed them all, and I was able to maintain
my weight because I was breastfeeding all of my children.” In fact, losing
weight while breastfeeding was frowned upon, as this could endanger the
quality of breast milk, as Elder [M4] remarked:
It’s not good for women to lose weight when breastfeeding. When a
woman loses weight when breastfeeding the breast milk is not going to be
as good as it should be. And then a woman shouldn’t lose weight while
they’re breastfeeding because when one is breastfeeding that’s the best
thing you can give to your child.
Despite the belief that weight gain, or at the very least maintenance, was
preferred during lactation, Elders did not report having difficulties returning to
their prepregnancy size. A subsistence lifestyle required a large amount of
physical activity, and so women postpartum had to eat to ensure their strength
to carry out their required duties and to produce milk for their infant.
DISCUSSION
A review of the literature documenting how lifestyle practices have
changed as a result of European colonization coupled with qualitative research
with Eeyou Elders who bore their children at a time when people still
predominantly lived in the bush provided a picture of mid-20th century
lifestyle practices of Eeyou women when pregnant and breastfeeding. In its
totality, this information could help frame advice for pregnant Eeyou women
in the 21st century. Elders focused on the shift away from a traditional
subsistence life, and the resultant change in diet and physical activity patterns
as the reasons for the health and weight challenges faced by so many

contemporary women during the reproductive years. As told by the Elders, in

addition to eating in moderation, women were traditionally encouraged to stay
active in pregnancy, for this would provide them with the strength and
endurance for childbirth, and ensured that their infants would have the
physical ability to participate in the process of labour. Despite the high cultural
valuation of dietary fat, when Elders were having their children the importance
of moderating weight gain in pregnancy was recognized partially through
choosing “light” foods relatively low in fat which had the added benefit of
mitigating nausea and vomiting (Vallianatos et al. 2008). These traditional
lifestyle practices as articulated by Elders could assist contemporary Eeyou
women to maintain a healthy body weight.
Culture is more than beliefs, practices, and values that are passed down
from generation to generation. It is a complex shifting process (Gray and
Thomas 2006) enacted relationally through history, experience, gender and
social position (Browne and Varcoe 2006). Eeyouch actively construct
meanings of personhood through food practices. Eeyou meechum has the
potential to connect Eeyouch across time and space, supporting understandings
and constructions of Eeyou-ness. Food choices then, are of concern to
communities and not just individuals; as such choices are representative of
identities. This was evident in Elders’ concerns about changing foodways,
noting that bush life and traditional Eeyou meechum continue to be highly
valued amongst Eeyou peoples.
From the Elders’ standpoints, eating “white man’s” food, most of which in
Eeyou Istchee communities is store-bought and restaurant food high in sugar
and fat, was easier for contemporary women with respect to the time and effort
required for food acquisition, processing, and preparation. Thus, in some ways
it is understandable why young women would make such choices. It is
difficult to resist the tasty, fat and sugar-rich foods that are now so readily
available, especially when employment-related time constraints makes
cooking a challenge (Vallianatos et al. 2006).
The increased reliance on white man’s food does not necessarily have
to equate with degradation in nutrition for women of childbearing age. In
the decades following permanent settlement, fruits and vegetables became
available year-round. The challenge for remote and economically marginalized
communities is to ensure quality fresh produce at affordable prices, and to
provide tastes amenable to Eeyou culinary traditions and palates considering
that fruits and vegetables have been described by some Eeyou as not tasty and
as “muskrat food” (a muskrat being an aquatic herbivorous mammal) (Boston
et al. 1997). Elders discussed the importance of getting together as a group

when they were young to learn how to prepare and cook unfamiliar but healthy
“white man’s” food. Contemporary young mothers have identified cooking
classes as desirable (Vallianatos et al. 2006) and there have been regular
cooking workshops and cooking classes offered in the region. These classes
not only allow for honing of culinary skills and encourage creativity in the
kitchen for store-bought foods, but also allow young women to learn the
merits of traditional foods and their required preparation methods while
concurrently incorporating healthy market foods. As an added benefit, the
sharing of food strengthens communal bonds, and provides some relief for
time-stressed parents. In part, due to time constraints by young mothers or lack
of childcare, participation rates and attendance at cooking classes in Eeyou
Istchee communities are sometimes low.
Not all advice provided by Elders would be appropriate in today’s
food environment. Breastfeeding is highly valued in Eeyou Istchee and
breastfeeding promotion strategies in the region sometimes include
information from Elders about the value of traditional foods for breastfeeding
mothers (e.g., “Fish broth is traditionally used to increase the quantity and the
richness of breastmilk.”) (Gauthier 2013). In the past, lactating mothers
practicing a subsistence lifestyle were encouraged to eat, for they had to
consume enough food to ensure the well-being of their infants and of
themselves (Vallianatos et al. 2006). Fish and game provide relatively little fat
compared with many of the store bought foods so prolific today, as illustrated
by the concept that “one cannot live on rabbit for long” (Flannery 1995)
because of the leanness of the meat. In contrast, given the abundance of highly
caloric processed foods consumed by women today, following the advice of
Elders to maintain or even gain weight while lactating might further contribute
to obesity (Vishwanathan et al. 2008). Current health advice is that once
breastfeeding is established, overweight or obese women should aim for a
slow weight loss of about 0.5 kg a week by choosing a variety of nutritious
foods and exercising (Institute of Medicine 2009).
For people in Eeyou Istchee, health is not simply about biological
wellbeing but quality of life as historically embedded within cultural, social
and political realities (Adelson 2000, 2001, 2005). A direct English translation
of Eeyou perceptions of health does not exist, but rather is represented by the
concept of miyupimaatisiiun, ‘being alive well.’ This term encompasses
emotional, spiritual and mental aspects of well-being, including being able to
conduct the physical activities necessary for daily life, to eat Eeyou meechum,
and to keep warm (Adelson 2000). Discourses of health in Eeyou Istchee must
therefore move beyond the boundaries of the physical body and connect

physiological wellness to cultural well-being (Adelson 2000; Loutitt 2005).

For Eeyou people, the “bush” is seen as a healing place and as a place to
withdraw from the “white man’s” community lifestyle, thus bush spaces such
as hunting camps might be culturally appropriate healing spaces to hold
prenatal and postnatal programs that incorporate an Eeyou understanding of
health and well-being (Louttit 2005).
The changing taste exhibited by the younger generations towards Eeyou
meechum and “white man’s” foods has implications for both the construction
of Eeyou identity and the health and well-being of young Eeyou women.
Based on the cultural importance and nutritional significance of Eeyou
meechum, the best strategy to promote health and wellness among Eeyou
people of any age might be the continued consumption of traditional food in
combination with healthy non-indigenous (i.e., store-bought) foods. However,
health promotion strategies must be respectful of the fact that younger Eeyou
might be less inclined than older Eeyou to consider the consumption of Eeyou
meechum as integral to their sense of Eeyou identity (Louttit 2005). Young
women of childbearing age may also resent being ‘preached at’ from Elders,
and being told that if they don’t know the traditional practices then they don’t
know Eeyou ways (Louttit 2005). In other words, women must decide for
themselves what their particular worldview will encompass about traditions
and modernity in the 21st century (Louttit 2005).
CONCLUSION
Health professionals working in Eeyou Istchee might consider the
increased integration of biomedicine, indigenous concepts of health and
illness, sociopolitical and historical circumstances that have shaped indigenous
health, and cultural context into patient care; thereby, transforming health care
practice to be inclusive of both Western and Indigenous ways of knowing
(Loutitt 2005; Tarlier et al. 2013). Efforts by health professionals to tackle
obesity and obesity-related illnesses among Eeyou women of childbearing age
might benefit from being multifactorial, integrative of local communities, and
consistent with traditional concepts of health and well-being (Boston et al.
1997; Louttit 2005; Special Working Group, Cree Regional Child and Family
Services 2000; Willows et al. 2012). Health care professionals working with
Eeyou women requiring prenatal and postnatal lifestyle counseling could
consider integrating traditional practices or approaches to health care when the
client needs or wants them (Dobbelsteyn 2006). To do this, health care

professionals might benefit from the inclusion of cultural brokers, Elders and
traditional healers as members of the healthcare team (Long and Curry 1998).
ACKNOWLEDGMENTS
We are grateful for the time and knowledge shared by the Eeyou Elders
who participated in interviews. The Cree Board of Health and Social Services
of James Bay (Quebec) supported this study. We are grateful to Erin Brennand
for conducting the semi-structured interviews with Elders. When interviews
were obtained, Helen Vallianatos and Noreen Willows were investigators with
the Promotion of Optimal Weight through Ecological Research (POWER)
group, funded by the Canadian Institutes for Health Research in partnership
with the Heart and Stroke Foundation of Canada. Noreen Willows was
supported by a Health Scholar Award from Alberta Innovates Health Solutions
at the time of writing of this manuscript.
REFERENCES
Adelson, Naomi. 2000. “Being Alive Well”: Health and the Politics of Cree
Well-being. Toronto, ON: University of Toronto Press.
Adelson, Naomi. 2001. “Gathering knowledge: Reflections on the
anthropology of identity, aboriginality, and the annual gatherings in
Whapmagoostui, Quebec.” In Aboriginal Autonomy and Development in
Northern Quebec and Labrador, edited by Colin H. Scott, 289-303.
Vancouver, BC: University of British Columbia Press.
Adelson, Naomi. 2005. “Appreciation of the goose: The relationship between
food, gender and respect amongst the Iiyiyu'ch of Great Whale, Québec.”
In Gendered Intersections: An Introduction to Women's and Gender
Studies, edited by C. Lesley Biggs and Pamela J. Downe, 276-279.
Halifax, NS: Fernwood Publishing.
Belinsky, D. L., and Harriet V. Kuhnlein. 2000. “Macronutrient, mineral and
fatty acid composition of Canada goose (Branta canadensis): An
important traditional food resource of the Eastern James Bay Cree of
Quebec.” Journal of Food Composition and Analysis, 13:101-115.

Belinsky, D. L., Harriet V. Kuhnlein, F. Yegoah, A.F. Penn and H.M. Chan.
1996. “Composition of fish consumed by the James Bay Cree.” Journal of
Food Composition and Analysis, 9:148-162.
Berkes, Fikret, and Carol S. Farkas. 1978. “Eastern James Bay Cree Indians:
Changing patterns of wild food use and nutrition.” Ecology of Food and
Nutrition, 7:155-172.
Bobet, Ellen. 2013. Summary Report on the Nituuchischaayihtitaau Aschii
Multi-Community Environment-and-Health Study. Public Health Report
Series 4 on the Health of the Population. Chisasibi, QC: Cree Board of
Health and Social Services of James Bay.
Boston, Patricia, Steven Jordan, Elizabeth MacNamara, Karne Kozolanka,
Emily Bobbish-Rondeau, Helen Iserhoff, Susan Mianscum, Rita
Mianscum-Trapper, Irene Mistacheesick, Beatrice Petawabano, Mary
Sheshamush-Masty, Rosie Wapachee and Juliet Weapenicappo. 1997.
“Using Participatory Action Research to Understand the Meanings
Aboriginal Canadians Attribute to the Rising Incidence of Diabetes.”
Chronic Diseases in Canada, 18:5-12.
Browne, Annette J., and Colleen Varcoe. 2006. “Critical cultural perspectives
and health care involving Aboriginal peoples.” Contemporary Nurse,
22:155-67.
Bruce, Sharon G., Natalie D. Riediger, James M. Zacharias, T. Kue Young.
2011. “Obesity and obesity-related comorbidities in a Canadian First
Nation population.” Preventing Chronic Disease, 8:A03.
DeVault, Marjorie. 1990. “Talking and listening from women’s standpoints:
feminist strategies for interviewing and analysis.” Social Problems, 37:96-
116.
Dewailly, Eric, Carole Blanchet, Suzanne Gingras, Simone Lemieux, and
Bruce J. Holub. 2002. « Cardiovascular disease risk factors and n-3 fatty
acid status in the adult population of James Bay Cree.” American Journal
of Clinical Nutrition, 76:85-92.
Dobbelsteyn, Jennifer L. 2006. “Nursing in First Nations and Inuit
communities in Atlantic Canada.” Canadian Nurse, 102:32-35.
Downs, Shauna M., Amber Arnold, Dru Marshall, Linda J. McCargar, Kim D.
Raine, and Noreen D. Willows. 2009. “Associations among the food
environment diet quality and weight status in Cree children in Québec.”
Public Health Nutrition, 12:1504–1511.
Duquette, Marie-Paule, Candice Scatliff, and Janine D. Choquette. 2013.
Access to a Nutritious Food Basket in Eeyou Istichee. Montreal Diet

Dispensary. Report available at: www.creehealth.org/sites/default/files/

Nutritious%20Food%20Basket%20Report%20FINAL%202013.3.pdf.
Dyck, Roland, Nathaniel Osgood, Ting H. Lin, Amy Gao, and Mary R. Stang.
2010. “Epidemiology of diabetes mellitus among First Nations and non-
First Nations adults.” Canadian Medical Association Journal, 182:249-
256.
Feit, Harvey. 2004. “Hunting and the quest for power. The James Bay
Cree and Whiteman development.” In Native Peoples: The Canadian
Experience, 3rd edition, edited by R. Bruce Morrison and C. Roderick
Wilson, 101-128. Toronto, ON: Oxford University Press.
Flannery, Regina. 1995. Ellen Smallboy: Glimpses of a Cree Woman’s Life.
Montreal and Kingston: McGill-Queen’s University Press.
Francis, Daniel, and Toby Morantz. 1983. Partner in Furs: A History of the
Fur Trade in Eastern James Bay, 1600-1870. Montreal and Kingston:
McGill-Queen’s University Press.
Garriguet, Didier. 2008. “Obesity and the eating habits of the Aboriginal
population.” Health Reports, 19:1-15.
Gauthier, Dany. 2013. “Breastfeeding Index Cards.” Cree Board of Health
and Social Services of James Bay. Accessed May 9, 2016 at:
http://www.creehealth.org/sites/default/files/Index%20cards_V9(14mars)
FINAL.pdf.
George, Peter, Fikret Berkes, and Richard J. Preston. 1995. “Aboriginal
harvesting in the Moose River Basin: A historical and contemporary
analysis.” Canadian Review of Sociology and Anthropology, 32:69-90.
Gray, Patricia D., and Debera J. Thomas. 2006. “Critical reflections on culture
in nursing.” Journal of Cultural Diversity, 13:76-82.
Hanson, Robert L., Yunhua L. Muller, Sayuko Kobes, Tingwei Guo, Li Bian,
Victoria Ossowski, Kim Wiedrich, Jeffrey Sutherland, Christopher
Wiedrich, Darin Mahkee, Ke Huang, Maryam Abdussamad, Michael
Traurig, E Jennifer Weil, Robert G Nelson, Peter H Bennett, William C
Knowler, Clifton Bogardus, Leslie J Baier. 2013. “A Genome-
Wide Association Study in American Indians Implicates DNER as a
Susceptibility Locus for Type 2 Diabetes Mellitus.” Diabetes,
DB_130416.
Harrison, Jane, Lesley MacGibbon, and Missy Morton. 2001. “Regimes of
trustworthiness in qualitative research: the rigors of reciprocity.”
Qualitative Inquiry, 7, 323-345.
Hart-Wasekeesikaw, Fjola. 2009. Cultural Competence and Cultural Safety in
Nursing Education: A Framework for First Nations, Inuit and Métis

Nursing. Making it Happen: Strengthening First Nation, Inuit and Métis

Health Human Resources. Ottawa, ON: Aboriginal Nurses Association of
Canada.
Institute of Medicine. 2009. Weight gain during pregnancy: Reexamining the
guidelines. Washington, DC: National Academies Press.
Johnson-Down, Louise M., and Grace M. Egeland. 2012. “How is nutrition
transition affecting dietary adequacy in Eeyouch (Cree) adults of Northern
Quebec, Canada?” Applied Physiology, Nutrition, and Metabolism,
38:300-305.
Johnson-Down, Louise, M. E. Labonte, I. D. Martin, L. J. S. Tsuji, E. Nieboer,
E. Dewailly, Grace M. Egeland, and M. Lucas. 2015. “Quality of
diet is associated with insulin resistance in the Cree (Eeyouch)
indigenous population of northern Québec.” Nutrition, Metabolism and
Cardiovascular Diseases, 25:85-92.
Kirmayer, Laurence J., Lucy J. Boothroyd, Adrian Tanner, Naomi Adelson,
and Elizabeth Robinson. 2000. “Psychological distress among the Cree of
James Bay.” Transcultural Psychiatry, 37:35-56.
Liu, S. L., B. R. Shah, M. Naqshbandi, V. Tran, and S.B. Harris. 2012.
“Increased rates of adverse outcomes for gestational diabetes and
pre-pregnancy diabetes in on-reserve First Nations Women in Ontario,
Canada.” Diabetic Medicine, 29:e180–e183. doi: 10.1111/j.1464-
5491.2012.03691.x.
Long, Claudia R., and Mary A. Curry. 1998. “Living in two worlds: Native
American women and prenatal care.” Health Care Women International,
19, 205-215.
Loutitt, S. 2005. Diabetes and Glimpses of a 21st Century Eeyou (Cree)
Culture: Local Perspectives on Diet, Body Weight, Physical Activity and
'Being' Eeyou Among an Eeyou Youth Population of the Eeyou (Cree)
Nation of Wemindji, Quebec. Sociology and Anthropology Master of Arts
Thesis. Carlton: Carlton University.
Morantz, Toby E. 1983. An Ethnohistoric Study of Eastern James Bay Cree
Social Organization, 1700-1850. Ottawa, ON: National Museum of Man.
Morantz, Toby E. 2002. The White Man’s Gonna Getcha: The Colonial
Challenge to the Crees in Quebec. Montreal and Kingston: McGill-
Queen’s University Press.
Nieboer, E., E. Dewailly, L. Johnson-Down, H. Sampasa-Kanyinga, M.-L.
Château-Degat, G.M. Egeland, L. Atikessé, E. Robinson, and Jill Torrie.
2013. Nituuchischaayihtitaau Aschii. Multi-community Environment-and-
Health Study in Eeyou Istchee 2005-2009: Final Technical Report. Public

Health Report Series 4 on the Health of the Population. Chisasibi, QC:

Cree Board of Health and Social Services of James Bay.
Niezen, Ronald. 1993. “Power and dignity: The social consequences of hydro-
electric development for the James Bay Cree.” Canadian Review of
Sociology and Anthropology, 30:510-529.
Niezen, Ronald. 1997. “Healing and conversion: medical evangelism in James
Bay Cree society.” Ethnohistory, 44:463-491.
Niezen, Ronald. 1998. Defending the Land: Sovereignty and Forest Life in
James Bay Cree Society. Boston: Allyn and Bacon.
Oster, Richard T., Malcolm King, Donald W. Morrish, Maria J. Mayan, and
Ellen L. Toth. 2014. “Diabetes in pregnancy among First Nations women
in Alberta, Canada: a retrospective analysis.” BMC Pregnancy and
Childbirth, 14:136.
Popenoe, Rebecca. 2004. Feeding Desire: Fatness, Beauty, and Sexuality
Among a Saharan People. New York, NY: Routledge.
Preston, Richard J. 1981. “East Main Cree.” In Handbook of North American
Indians. volume 6, Subarctic, edited by June Helm, 196-207. Washington,
D.C.: Smithsonian Institution.
Preston, Richard J. 2002. Cree Narrative. 2nd edition. Montreal and Kingston:
McGill-Queen’s University Press.
Ravussin, Eric, Mauro E. Valencia, Julian Esparza, Peter H. Bennett, and
Leslie O. Schulz. 1994. “Effects of a traditional lifestyle on obesity in
Pima Indians.” Diabetes Care, 17:1067-1074.
Rock, Melanie. 2003. “Sweet blood and social suffering: Rethinking
cause-effect relationships in diabetes, distress, and duress.” Medical
Anthropology, 22:131-174.
Special Working Group of the Cree Regional Child and Family
Services Committee. 2000. “Planning research for greater community
involvement and long-term benefit.” Canadian Medical Association
Journal, 163:1273-1274.
Tarlier, Denise S., and Annette J. Browne. 2011. “Remote Nursing Certified
Practice: Viewing nursing and nurse practitioner practice through a social
justice lens.” Canadian Journal of Nursing Research, 43:38–61.
Tarlier, Denise S., Joy L. Johnson, Annette J. Browne, and Sam Sheps. 2013.
“Maternal-infant health outcomes and nursing practice in a remote First
Nations Community in Northern Canada.” CJNR (Canadian Journal of
Nursing Research), 45:76-100.
Torrie, Jill, Ellen Bobet, Natalie Kishchuk, and Andrew Webster. 2005a. The
Evolution of Health Status and Health Determinants in the Cree Region

(Eeyou Istchee): Eastmain 1-A Powerhouse and Rupert Diversion

Sectoral Report. Volume 2: Detailed Analysis. Chisasibi, QC: Cree Board
of Health and Social Services of James Bay.
Torrie, Jill, Ellen Bobet, Natalie Kishchuk, and Andrew Webster. 2005b. The
Evolution of Health Status and Health Determinants in the Cree Region
(Eeyou Istchee): Eastmain 1-A Powerhouse and Rupert Diversion
Sectoral Report. Volume 1: Context and Findings. Chisasibi, QC: Cree
Board of Health and Social Services of James Bay.
Tulloch-Reid, Marshall K., Desmond E. Williams, Helen C. Looker, Robert L.
Hanson, and William C. Knowler. 2003. “Do measures of body fat
distribution provide information on the risk of type 2 diabetes in addition
to measures of general obesity? Comparison of anthropometric predictors
of type 2 diabetes in Pima Indians.” Diabetes Care, 26:2556-2561.
Ulijaszek, Stanley J., and Hayley Lofink. 2006. Obesity in biocultural
perspective. Annual Review of Anthropology, 35:337-360.
Vallianatos, Helen, Erin A. Brennand, Kim D. Raine, Queenie Stephen,
Beatrice Petawabano, Daniel Dannenbaum and Noreen D. Willows. 2006.
“First Nations women’s beliefs and practices concerning weight gain in
pregnancy and lactation: Implications for women’s health.” Canadian
Journal of Nursing Research, 38:102–119.
Vallianatos, Helen, Erin A. Brennand, Kim D. Raine, Queeni Stephen,
Beatrice Petawabano, Daniel Dannenbaum, and Noreen D. Willows. 2008.
“Cree women speak: Intergenerational perspectives on weight gain during
pregnancy and weight loss after pregnancy.” Journal of Aboriginal
Health, 4:6-14.
Viswanathan, Meera, Anna M. Siega-Riz, Merry K. Moos, Andrea Deierlein,
Sunni Mumford, Julie Knaack, Patricia Thieda, Linda J. Lux, and
Kathleen N. Lohr. 2008. Outcomes of Maternal Weight Gain, Evidence
Report/Technology Assessment No. 168. AHRQ Publication No. 08-E009.
Rockville, MD: Agency for Healthcare Research and Quality.
Wheelock, Kevin M., Madhumita Sinha, William C. Knowler, Robert G.
Nelson, Gudeta D. Fufaa, and Robert L. Hanson. 2016. “Metabolic Risk
Factors and Type 2 Diabetes Incidence in American Indian Children.” The
Journal of Clinical Endocrinology and Metabolism, 101:1437-1444.
Willows, Noreen D. 2005. “Determinants of healthy eating in Aboriginal
peoples in Canada: The current state of knowledge and research gaps.”
Canadian Journal of Public Health, 96:S32-S36.
Willows, Noreen D., Anthony J. Hanley, and Treena Delormier. 2012. “A
socioecological framework to understand weight-related issues in

Aboriginal children in Canada.” Applied Physiology, Nutrition and

Metabolism, 37:1-13.
Willows, Noreen D., Rose Iserhoff, Lily Napash, Lucie Leclerc, and Tanya
Verrall. 2005. “Anxiety about food supply in Cree women with infants in
Quebec.” International Journal of Circumpolar Health, 64:55-64.
Willows, Noreen D., Dru Marshall, Kim D. Raine, and Denise C. Ridley.
2009. “Diabetes awareness and body size perceptions of Cree
schoolchildren.” Health Education Research, 24:1051-1058.
Willows, Noreen D., Denise Ridley, Kim D. Raine, Katerina Maximova. 2013.
“High adiposity is associated cross-sectionally with low self-concept and
body size dissatisfaction among indigenous Cree schoolchildren in
Canada.” BMC Pediatrics, 13:118.
Willows, Noreen D., Dia Sanou, and Rhonda C. Bell. 2011. “Assessment of
Canadian Cree infants' birth size using the WHO Child Growth
Standards.” American Journal of Human Biology, 23:126-31.
BIOGRAPHICAL SKETCHES
Name: Helen Vallianatos
Affiliation: University of Alberta
Education:
Doctor of Philosophy, Department of Anthropology, University of

Oregon, 2004
Graduate Certificate, Women’s and Gender Studies Program, University
of Oregon, 2004
Address:
13-22 Tory Building, Department of Anthropology, University of Alberta,

Edmonton, AB, Canada T6G 2H4
The theoretical and methodological foundations for my approach to

investigating health experiences and behaviours of women are centered on my

award-winning dissertation (2006) from the International Institute for

Qualitative Methodology. This resulted in the publication of my dissertation as
a book entitled Poor and Pregnant in New Delhi, India, and this book was
later reprinted in India. I conducted a critical ethnography of rural migrant
multiparous women using a biocultural anthropological approach—this
approach situates human health within its historical (e.g., colonialism and its
aftereffects), sociocultural (e.g., gender roles, food and health beliefs), and
political-economic (e.g., international development aid, government food and
health programs) contexts. An important component to my research standpoint
was applying feminist analysis to understand how gender intersected with
other aspects of these mothers’ identities (e.g., age, caste, social class, religion,
etc.) in shaping their health and nutrition choices.
In my postdoctoral research in health promotion and public health, I
further expanded my theoretical knowledge by immersing myself in social
determinants of health literature and holistic ecological approaches; these
approaches provided me with further tools to critically assess factors creating
opportunities and challenges to healthy living. This included work with First
Nations mothers and Elders on how socioenvironmental factors and colonial
histories affected health of themselves and their communities (e.g., Journal of
Aboriginal Health article).
Continuing to expand my methodologies in order to help participants
articulate health and nutrition beliefs, I began using visual approaches. This
has resulted in a number of studies utilizing photovoice or variations,
including the work published in the book Acquired Tastes, Social Science
and Medicine, Agriculture and Human Values, BMC Pregnancy and
Childbirth, as well as methodological pieces published in International
Journal of Qualitative Methodology and in an edited volume entitled Research
Methods for the Anthropological Study of Food and Nutrition by Berghahn
Books that is currently in press. All studies utilized critical social theories. The
book Acquired Tastes was the result of a collaborative endeavor across 5
places in Canada (led by Drs. G. Chapman and B. Beagan) exploring healthy
eating beliefs and practices and how these were influenced by social class. We
used photo elicitation and photovoice to investigate food beliefs and practices.
Articles in Social Science and Medicine and Agriculture and Human Values
contextualized health in social and built environments, using photovoice. The
BMC Pregnancy and Childbirth article reported on a study with immigrant
and refugee women, also employing photovoice. The power of visual
approaches more recently informed my visual dissemination activities,
including a short film called Play Across the Seasons (approx. 12 min) based

on a collaborative study examining parent perceptions and practices involving

play activities with their children (and also used a photovoice methodology),
and a web resource from a CIHR funded study on immigrant mother’s food
choices and practices during pregnancy (see: http://www.nottingham.
ac.uk/helm/dev/chir).
Associate Dean, Office of the Dean of Students, University of Alberta,

2015-Present
Associate Professor, Department of Anthropology, University of Alberta,
2012-Present
Associate Chair (Undergraduate Programs), Department of Anthropology,
University of Alberta, 2013-2016
Adjunct Associate Professor, Centre for Health Promotion Studies, School
of Public Health, University of Alberta, 2007-Present
Academic Member, Women’s and Children’s Health Research Institute,
2009-Present
Honors (selected):
Research Excellence Award, Faculty of Arts, University of Alberta, 2016

Undergraduate Teaching Award, Faculty of Arts, University of Alberta,
2012
International Institute for Qualitative Methodology Dissertation Award,
2006
Selected Publications Last 3 Years:
Books
Schultes, A. and Vallianatos, H. (Eds.) (in press) The Migrant Maternal:
Birthing New Lives Abroad. Toronto, ON: Demeter Press.
Beagan, B., Chapman, G., Johnston, J., McPhail, D., Power, E. and
Vallianatos, H. 2015. Acquired Tastes: Why Families Eat the Way they
Do. Vancouver, BC: University of British Columbia Press. (280 pages)
Refereed Journal Articles (my students underlined)
Higginbottom, G., Vallianatos, H., Shankar, J., Osswald, B. and Davey, C. (in
press) Understanding South Asian immigrant women’s food choices in the
perinatal period. International Journal of Women’s Health and Wellness.

Ramos Salas, X., Vallianatos, H., Spence, J.C. and Raine, K. (in press) Socio-
cultural determinants of physical activity among Latin American
immigrant women in Alberta, Canada. Journal of International Migration
and Integration.
Belon, A.P., Nieuwendyk, L.M., Vallianatos, H. and Nykiforuk, C.I.J. 2016.
Community lenses revealing the role of sociocultural environment on
physical activity. American Journal of Health Promotion. 30(3):e92-e100.
Hammer, B.A., Vallianatos, H., Nykiforuk, C.I.J. and Nieuwendyk, L.M. 2015.
Perceptions of healthy eating in four Alberta communities: A photovoice
project. Agriculture and Human Values 32:649-662.
Higginbottom, G., Mamede, F., Barolia, R., Vallianatos, H. and Chambers, T.
2014. Aboriginal and immigrant women’s food choices and practices in
pregnancy: a scoping review. Canadian Journal of Midwifery Research
and Practice 13(1):16-35.
Higginbottom, G., Vallianatos, H., Forgeron, J., Gibbons, D., Mamede, F. and
Barolia, R. 2014. Food choices and practices during pregnancy of
immigrant women with high-risk pregnancies in Canada: a pilot study.
BMC Pregnancy and Childbirth 14:370-383. doi:10.1186/s12884-014-
0370-6
Belon, A.P., Nieuwendyk, L.M., Vallianatos, H. and Nykiforuk, C.I.J. 2014.
How community environment shapes physical activity: Perceptions
revealed through the photovoice method. Social Science and Medicine
116:10-21.
Steadman, R., Nykiforuk, C.I.J. and Vallianatos, H. 2013. Active aging:
Hiking, Health and Healing. Anthropology and Aging Quarterly 34(3):
87-99.
Refereed Chapter in Edited Volumes (my students underlined)
Vallianatos, H. (in press) Changing places, changing bodies: Reproducing
families through food. In A. Schultes and H. Vallianatos (Eds.) The
Migrant Maternal: Birthing New Lives Abroad. Toronto, ON: Demeter
Press.
Ali, H.M.A. and Vallianatos, H. (in press) Indigenous foodways in the
Chittagong Hill Tracts of Bangladesh: an alternative-additional food
network. In M. Wilson (Ed.) Postcolonialism, Indigeneity and Struggles
for Food Sovereignty: Alternative Food Networks in Postcolonial Spaces.
London, UK: Routledge.
Vallianatos, H. and Raine, K. (in press) Consuming food and constructing
identities among Arabic and South Asian immigrant women. In M. Epp
and F. Iacovetta (Eds.) Sisters or Strangers? Immigrant, Ethnic and

Racialized Women in Canadian History. 2nd edition. Toronto, ON:

University of Toronto Press. (NB: shortened version of previously
published article)
Vallianatos, H. (in press) Visual anthropology methods. In J. Brett and J.
Chrzan (Eds.) Research Methods for the Anthropological Study of Food
and Nutrition. Berghahn Books.
Vallianatos, H. (in press) Photo-video voice. In J. Brett and J. Chrzan (Eds.)
Research Methods for the Anthropological Study of Food and Nutrition.
Berghahn Books.
Vallianatos, H., Hadziabdic, E. and Higginbottom, G. 2015. Designing
participatory research projects. In G. Higginbottom and P. Liamputtong
(Eds.) Using Participatory Qualitative Research Methodologies in Health,
40-58. London, UK: Sage.
Vallianatos, H. 2014. Eating, feeding and the human lifecycle. In P.B.
Thompson and D.M. Kaplan (Eds.) Encyclopedia of Food and
Agricultural Ethics, pp. 506-512. New York, NY: Springer. DOI:
10.1007/978-94-007-6167-4_41-1.
Name: Noreen Willows
Affiliation: Department of Agricultural, Food and Nutritional Science;

Faculty of Agricultural, Life and Environmental Sciences, University of
Alberta
Education: Doctor of Philosophy in Human Nutrition, School of Dietetics

and Human Nutrition, McGill University, 2000
Address:
Department of Agricultural, Food and Nutritional Science
4-378 Edmonton Clinic Health Academy
Mailbox #54
11405 87 Avenue
Edmonton, Alberta, Canada
T6G 2P5

I am Associate Professor of Community Nutrition in the Department of

Agricultural, Food and Nutritional Science at the University of Alberta. I have
academic training in Human Nutrition (PhD, McGill University), Archaeology
(MA, University of Calgary) and Anthropology (BSc with distinction,
University of Calgary). Since 1996 I have engaged in research to address
nutrition, food security and healthy body weights in indigenous communities
in Canada. I hold a 7-year (2010-2017) Health Scholar award from Alberta
Innovates Health Solutions to undertake population health intervention
research to enhance food security in First Nations communities in the province
of Alberta.
Culturally sensitive research to improve indigenous peoples’ nutrition and
health is of critical importance in Canada considering the high prevalence of
chronic diseases in indigenous groups. My career path as a researcher trying to
address indigenous nutrition and health has taken me from clinical and
epidemiological research about infant childhood anemia, to community-based
health assessments of childhood weight status and nutrition, and now to
population intervention research to prevent food insecurity. Food insecurity is
the state of being without reliable access to a sufficient quantity of affordable,
nutritious food. For indigenous peoples, lack of access to cultural foods is also
a key aspect of food insecurity. This body of research has 1) advanced
knowledge of the epidemiology and determinants of anemia and obesity in
First Nations communities, 2) engaged community leaders as participants in
considering the implications of the research for the health of their
communities, and 3) informed the research community about developing a
participatory process for designing culturally-sensitive health promotion
programs. A major contribution to knowledge development from my research
is a furthered understanding of the social determinants of health in indigenous
populations, and the requirement for health interventions to include the social
determinants of health. The majority of my publications include my academic
trainees as co-authors. Graduate student mentorship is one of the most
satisfying aspects of my academic career.
I adopt a community-based participatory approach to research in
indigenous communities whereby community members and academic
researchers come together as equal partners to find culturally appropriate
solutions to health concerns. Community-based participatory research
acknowledges that each partner brings unique strengths to the research
process. It begins with a research topic of importance to the community and

aims to improve health outcomes and eliminate health disparities. With

indigenous partners, I have written academic articles about the importance of
the community-based participatory research process to achieve health
outcomes.
Associate Professor, Department of Agricultural, Food and Nutritional

Science, University of Alberta, 2008 – present
Honors:
Health Scholar, Alberta Innovates Health Solutions, 2010-2017
Department of Agricultural, Food and Nutritional Science Teaching Wall

of Fame "Teachers of the Year" for the 2014-2015 academic year.
2013 Centrum Foundation New Scientist Award of the Canadian Nutrition

Society in recognition of outstanding research in nutrition
Journal articles
1. Atkey K, Raine, K. D., Storey, K. E. and Willows, N. D.. (2016).

A Public Policy Advocacy Project to Promote Food Security:
Exploring Stakeholders’ Experiences. Health Promotion Practice. pii:
1524839916643918. [Epub ahead of print]
2. Hanbazaza, M, Ball, G. D., Farmer, A, Maximova, K. and Willows,
N. D. (2016) Filling a need: Sociodemographic and educational
characteristics among student clients of a University-based campus
food bank. Journal of Hunger and Environmental Nutrition, 1-9.
3. Munasinghe, L. L., Willows, N., Yuan, Y. and Veugelers, P. J.
(2015). The prevalence and determinants of use of vitamin D
supplements among children in Alberta, Canada: a cross-sectional
study. BMC Public Health, 15(1), 1.
4. Munasinghe, L. L., Willows, N., Yuan, Y. and Veugelers, P. J.
(2015). Dietary reference intakes for vitamin D based on the revised

2010 dietary guidelines are not being met by children in Alberta,

Canada. Nutrition Research, 35(11), 956-964.
5. Hanbazaza, M. A., Triador, L., Ball, G. D., Farmer, A., Maximova,
K., Alexander First Nation, and Willows, N. D. (2015). The impact of
school gardening on Cree children's knowledge and attitudes toward
vegetables and fruit. Canadian Journal of Dietetic Practice and
Research, 76(3): 133-139.
6. Farahbakhsh, J., Ball, G. D., Farmer, A. P., Maximova, K.,
Hanbazaza, M. and Willows, N. D. (2015). How do student clients of
a university-based food bank cope with food insecurity?. Canadian
Journal of Dietetic Practice and Research, 76(4), 200-203.
7. Genuis, S. K., Willows, N., Nation, A. F. and Jardine, C. G.
(2015). Partnering with Indigenous student co-researchers: improving
research processes and outcomes. International Journal of
Circumpolar Health, 74. Jul 27;74:27838.
8. Willows, N., Dyck Fehderau, D. and Raine, K. D. (2015). Analysis
Grid for Environments Linked to Obesity (ANGELO) framework to
develop community‐driven health programmes in an Indigenous
community in Canada. Health and Social Care in the Community. doi:
10.1111/hsc.12229.
9. Strawson, C., Bell, R. C., Farmer, A., Downs, S. M., Olstad, D. L. and
Willows, N. D. (2015). Changing Dietary Habits of Alberta Nutrition
Students Enrolled in a Travel Study Program in Italy. Canadian
Journal of Dietetic Practice and Research, 76(2), 93-96.
10. Triador, L., Farmer, A., Maximova, K., Willows, N. and Kootenay, J.
(2015). A school gardening and healthy snack program increased
Aboriginal First Nations children's preferences toward vegetables and
fruit. Journal of nutrition education and behavior, 47(2), 176-180.
11. Watanabe, T., Berry, T. R., Willows, N. D. and Bell, R. C. (2015).
Assessing Intentions to Eat Low-Glycemic Index Foods by Adults
with Diabetes Using a New Questionnaire Based on the Theory of
Planned Behaviour. Canadian Journal of Diabetes, 39(2), 94-100.
12. Hamel C, Stevens A, Singh K, Ansari MT, Myers E, Ziegler P,
Hutton B, Sharma A, Bjerre LM, Fenton S, Lau DC, O'Hara K, Reid
R, Salewski E, Shrier I, Willows N, Tremblay M, Moher D. (2014).
Do sugar-sweetened beverages cause adverse health outcomes in
adults? A systematic review protocol. Systematic reviews, 3(1), 108.
13. Stevens A, Hamel C, Singh K, Ansari MT, Myers E, Ziegler P,
Hutton B, Sharma A, Bjerre LM, Fenton S, Gow R, Hadjiyannakis S,

O'Hara K, Pound C, Salewski E, Shrier I, Willows N, Moher D,

Tremblay M. (2014) Do sugar-sweetened beverages cause adverse
health outcomes in children? A systematic review protocol. Syst Rev.
2014 Sep 4;3:96.
14. Yu, Y. H., Farmer, A., Mager, D. and Willows, N. (2014). Dietary
sodium intakes and food sources of sodium in Canadian-born and
Asian-born individuals of Chinese ethnicity at a Canadian university
campus. Journal of American College Health, 62(4), 278-284.
15. Genius S, Willows N, Alexander First Nation, Jardine C. (2014)
Through the lens of our cameras: Children’s lived experience with
food security in a Canadian Indigenous Community. Child: Care,
Health and Development. doi: 10.1111/cch.12182.
16. Levay AV, Mumtaz Z, Rashid SF, Willows N. (2013) Influence of
gender roles and rising food prices on poor, pregnant women's eating
and food provisioning practices in Dhaka, Bangladesh. Reproductive
Health 10(1), 53.
17. Willows N. Ethical principles of health research involving Indigenous
peoples. (2013) Applied Physiology, Nutrition, and Metabolism
38(11):iii-v. doi: 10.1139/apnm-2013-0381.
18. Willows ND, Ridley D, Raine KD, Maximova K.M (2013) High
adiposity is associated cross-sectionally with low self-concept and
body size dissatisfaction among indigenous Cree schoolchildren in
Canada. BMC Pediatr. Aug 12;13:118. doi: 10.1186/1471-2431-13-
118.
19. Pigford AE, Dyck Feherau D, Ball GDC, Holt NL, Plotnikoff
RC, Veugelers PJ, Arcand E, Alexander First Nation, Willows ND
(2013) Community-based participatory research to address childhood
obesity; Experiences from Alexander First Nation in Canada.
Pimatisiwin: A Journal of Indigenous and Aboriginal Community
Health. 11(2):171-185.
20. Dyck Fehderau D, Holt NL, Ball GD, Alexander First Nation,
Willows ND. (2013) Feasibility study of asset mapping with children:
identifying how the community environment shapes activity and food
choices in Alexander First Nation. Rural and Remote Health
13(2):2289.
21. McMartin, S. E., Willows, N. D., Colman, I., Ohinmaa, A., Storey, K.
and Veugelers, P. J. (2013). Diet quality and feelings of worry,
sadness or unhappiness in Canadian children. Can J Public Health,
104(4), e322-e326.

22. Jessri, M., Farmer, A. P., Maximova, K., Willows, N. D. and Bell, R.
C. (2013). Predictors of exclusive breastfeeding: observations from
the Alberta pregnancy outcomes and nutrition (APrON) study. BMC
Pediatrics, 13(1), 77.
23. Strawson C, Bell R, Downs S, Farmer A, Olstad D, Willows N.
(2013) Dietary patterns of female university students with nutrition
education. Can J Diet Pract Res. 2013 Fall;74(3):138-42.
Articles in professional journals
Willows, N. (2015) Food security among Alberta First Nations. In: Food
Environment, Health, and Chronic Disease. Green Paper prepared for the
Alberta Institute of Agrologists. Editor: Catherine Chan, University of Alberta.
https://aia.in1touch.org/document/1911/Mar30_Green%20PaperFinal.pdf
Book Chapters
Willows, N. (2016) Food sources of calcium vary by ethnicity and

geography. Chapter 3. In: Calcium: chemistry, analysis, function and effects.
Victor Preedy, editor. Royal Society of Chemistry. Pages 30-45.
Willows, N. and Batal, M. (2013). Nutritional concerns of Aboriginal
infants and children in remote and northern Canadian communities: Problems
and therapies. In: Nutrition in Infancy (pp. 39-49). Humana Press.

Chapter 4
DISPARITIES IN MEDICATION USE AMONG

ELDER AMERICAN INDIANS: EVIDENCE,
CAUSES, AND IMPLICATIONS
Jane R. Mort,1 PharmD, FASCP,

and Chamika Hawkins-Taylor,2 MHA, PhD
Associate Dean and Professor
1
2
Assistant Professor
Pharmacy Practice, College of Pharmacy,
South Dakota State University, US
ABSTRACT
Elder American Indians account for 9% of all American Indians
and 1% of all US elders (65 years and older). American Indian elders
suffer poorer health, greater functional disability, and a shorter life-span
compared to the general US population. Poor health in the form of
multiple chronic conditions accounts for unique medication use issues.
However, little research exists on medication use and prescribing
practices for American Indian elders. Currently available medication use
data addresses polypharmacy, potentially inappropriate medication (PIM)
use, and management of select conditions common to American Indians.
Many of these studies are limited by lack of a comparator group, small
sample sizes, specific health care settings, and amount of time that has
transpired since data collection (1993 to 2009). However, this literature
indicates American Indian elders frequently receive polypharmacy (four

106 Jane R. Mort and Chamika Hawkins-Taylor
or more medications), have twice the odds of receiving a PIM, and often
receive suboptimal therapy for diabetes, lipid management, and asthma.
Health disparities which have been clearly identified for various
minority groups help to explain the differences in medication use
practices for American Indian elders. Yet limited research exists on
health disparities for American Indian elders. For this chapter, 25
prescription medication use issues that may potentially result in health
disparities are organized into six categories: access, social support,
patient characteristics, health beliefs/behaviors, health status, and
prescribing behaviors. Published data related to these factors among
American Indian elders provides some insight into the cause of
disparities. However, further research is needed to understand the impact
of these issues.
While limited information is available on medication use patterns in
the American Indian elder population, it appears that disparities exist.
Focused efforts are necessary to optimize the management of disease in
this population. However, well designed research is required to create
approaches that best meet the needs of this population.
INTRODUCTION
Elder American Indians (65 years and older) account for just over 9%
(492,605) of the 5.4 million American Indians and 1% of the 46 million
seniors in the United States as of 2014 (US Census Bureau, 2014a, US Census
Bureau, 2014b). By 2040 the number of American Indian elders will more
than double (Administration for Community Living [ACL], 2016). American
Indian elders are concentrated in several areas within the US. Specifically,
45% of the American Indian elders live in five states: Arizona, California,
New Mexico, North Carolina, and Oklahoma according to the Administration
on Aging (ACL, 2016). While this distribution in population may create
challenges for these states in meeting American Indian elders’ health needs, it
also provides an opportunity to focus services in confined geographic areas.
The definition of an elder in the American Indian population is somewhat
confusing because the Older Americans Act of 1965 allowed native tribes to
determine the age at which members could be designated as seniors and
correspondingly eligible for tribal services (John, 1996). Therefore, the
designation of elder differs among tribes. However, the US Census report
provides American Indian demographic data in categories (including age 65
years and older) which is consistent with typical elder definition (US Census
Bureau, 2014b). Variations in the age criteria defining elders are also found

Disparities in Medication Use among Elder American Indians 107
throughout health care research, although 65 years and older is the most
commonly employed definition.
Health status is an important variable to consider when examining
medication use. American Indian elders suffer poor health more often than the
general population. Examples include a high prevalence of arthritis, diabetes
and disabilities. For instance, 57% of this group suffers from arthritis
compared to 49% of all elderly (ACL, 2016). Similarly, older American Indian
adults experience higher rates of diabetes than the general population. In one
study as much as 42% of American Indians over 55 years of age reported
living with diabetes compared to national statistics showing 16% (Goins and
Pilkerton, 2010). In addition, American Indian elders experience higher rates
of functional disability (57.6% American Indian vs 41.9% all others 65 years
of age and older) (Moss, Schell, and Goins, 2006).
Even with these types of challenges, elder American Indians are said to be
living longer (ACL, 2016; Sequist, Cullen, and Acton, 2011). However, only
3.2% of the American Indian population live beyond 74 years old and life
expectancy is 4.4 years less than the general US population (US Census
Bureau, 2014b; US Department of Health and Human Services [DHHS],
2016). The shorter life expectancy may be due to the disproportionate
prevalence of chronic disease and health disparities (Sequist et al., 2011).
These complexities have significant financial ramifications.
In 2014 the annual cost of the Indian Health Services (IHS) was 5.8 billion
dollars (4.6 billion IHS funding, 1.2 billion third party payment) (Boccuti,
Swoope, and Artiga, 2014). Indian Health Service directly and indirectly treats
approximately 2 million American Indians, a population that includes the
elderly who have poorer health and experiences twice the hospital admissions
compared to all other elders (Boccuti et al., 2014; O’Connell, Wilson, Manson,
and Acton, 2012). O’Connell and colleagues estimated annual pharmacy costs
for the American Indian population in 2004-2005 to be more than $10 million,
with almost half of this amount supporting patients with diabetes (O’Connell
et al., 2012). Funding challenges exist within the IHS system in such forms as
equitable distribution of funds, lack of access to care, and limited urban
resources (Boccuti et al., 2014). The cost associated with caring for American
Indian elders makes service performance and sustainability a challenge, both
of which contribute to the health disparities among this population.

MEDICATION USE - AMERICAN INDIAN ELDERS

In the United States, American Indian elders have higher rates of poor
health according to a 2014 report by the National Center for Health Statistics
(US Department of Health and Human Services, 2014) which impacts
medication use patterns. While it is expected that medication use would be
greater among the American Indian elders due to the more frequent occurrence
of conditions, very little research has been published on medication use in this
population. In fact, common data sources for assessing medication use (i.e.,
Medical Expenditure Panel Survey, Sloan Survey, National Ambulatory and
Hospital Ambulatory Medical Care surveys) have not been used to study
American Indian elders. Even a comprehensive study of community-dwelling,
Medicare enrollees (2000 to 2008) failed to capture a subset of American
Indian elders (Briesacher et al., 2011; Henderson, Buchwald, and Manson,
2006). Other researchers combined American Indians with other minority
populations, limiting analysis (Rianon et al., 2015).
Therefore, only a very small number of studies have examined prescribing
practices for American Indian elders. These studies focused on prescribing
features such as polypharmacy or potentially inappropriate medication (PIM)
use and are limited by sampling features such as regional location, small
sample size, and variations in health care setting. An equally small number of
studies examined the management of specific chronic conditions in the
American Indian elder population. Currently available information suggests
that American Indian elders are receiving medication regimens that are less
optimal than that of the comparator groups (Mort and Sailor, 2011). While this
limited information draws attention to the concern, the paucity of data
confounds creation of specific interventions. The following is an overview of
the currently available information on medication prescribing for American
Indian elders.
POLYPHARMACY
Two studies examined the issue of polypharmacy in the elder American
Indian population. The larger study described medication use patterns for
American Indians using IHS data from over 500 health care settings in 39
states in the fiscal year 2009 (Berger, Correa, and Sims, 2010). The study
examined a total of 188,709 elders and found that 43% of the patients 50 years

and older received four or more prescriptions. For those 65 years and older in
this study, the percent rose to 45. This study is limited by the lack of a
comparator group.
A second study examined the relationship between polypharmacy and
quality of life in a sample of American Indian elders in Rapid City, South
Dakota. Using a sample of 63 members, the study found that the average
number of medications per patient was greater than nine for both males and
females (Henderson et al., 2006). As expected, patients with more chronic
conditions (arthritis, asthma, diabetes mellitus, emphysema, various cancers,
and hypertension) had a greater average number of medications (Henderson et
al., 2006). Use of more than 10 medications has been linked to inappropriate
prescribing or misuse of medications that may result in harmful, adverse
events (Jervis, Shore, Hutt, and Manson, 2007).
POTENTIALLY INAPPROPRIATE MEDICATIONS

Inappropriate medication use among elder American Indians was
examined in three studies based on the Beers criteria. The largest of the three
studies examined 1,423 American Indian elder beneficiaries (60,383 total
beneficiaries) in a South Dakota Medicare Part D database between April 1
and September 30 of 2009. Findings indicated that the odds of an American
Indian elder receiving a PIM was over two times greater than non-American
Indian elders (OR 2.39, CI 2.13-2.69) with 28.7% of American Indian elders
receiving a PIM compared to 14.4% for all other beneficiaries. The average
number of PIMs for American Indian elders was 3.3 compared with 2.8 for all
other participants (Mort and Sailor, 2011). The second largest study (n =
1,007) examining PIM use among elders was undertaken in a Cherokee Indian
Hospital between December 1, 2003 and December 1, 2004. Similar to the
South Dakota study, results showed that 31.7% of the patients over the age of
64 years received a PIM. Specifically, 319 patients received 553 PIMs for an
average of 1.7 PIMs per patient (Lamer, Rowe, Barnes, and Finke, 2005). The
third study contained the smallest sample (40 American Indians and 5
EuroAmerican) and took place in a tribal nursing home between September
2001 and July 2002. Thirteen received a PIM (30%). These results of the latter
study are challenging to interpret given that only 89% of the sample was
American Indians (Jervis et al., 2007).
While the total number of participants in these three PIM studies is low, it
should be pointed out that all three reported similar results with 29 to 32% of

American Indian elders receiving a PIM. The large percentage of American

Indian elders who received a PIM suggests work must be done to assure
prescribing is of high quality and in line with practice standards. Future
research is needed to understand prescribing practices for American Indian
elders in various health care settings and identify any disparities in care.
MEDICATION USE FOR THE MANAGEMENT

OF SPECIFIC CONDITIONS
Very few studies have explicitly examined medication use patterns for
specific conditions among American Indian elders. In fact, only three studies
were found that address American Indian elders. These studies addressed
management of diabetes, lipids, and asthma and were undertaken between
1996 and 2003.
The Evaluating Long-term Diabetes Self-management among Elder Rural
Adults Study (ELDER) examined glycemic control in 693 elderly patients in
rural North Carolina, pulling the sample from Medicare Claims Data in 2002
(Quandt et al., 2005). This report found that glycemic control was significantly
poorer among American Indian elders compared to African Americans and
whites, even after controlling for various factors. This disparity in outcomes
occurred despite the fact that all participants lived in the same two rural North
Carolina counties. The authors indicated that further research is needed to
determine the cause for the divergent health results (Quandt et al., 2005).
Statin use was examined in a Phoenix based IHS cohort of 2,095
American Indian patients with a diagnosis of coronary artery disease in 2003.
Results showed that a significantly lower percentage of elders, 80 years and
older, received statin therapy compared to younger American Indians (32.1%
of those over 80 years old, 44.3% of those 65-79 years old, 42.1% of those
under 65 years old). The authors pointed out that this is similar to studies
showing lower statin use for older patients (66 to 80 years old) (Cooke,
Bresette, and Khanna, 2006).
Asthma management was examined in American Indian elders (age
50 years and older) in the Strong Heart Study which took place between
1996 and 1999. This study examined 3,197 American Indians living in
Arizona, Oklahoma, North Dakota and South Dakota (Dixon et al., 2007).
Among the participants, 6.3% had physician diagnosed asthma with 52%
having “severe persistent disease” and frequent suboptimal management (3%

receiving corticosteroids on a daily basis and 58% prescribed a short acting

Beta Agonists). Care must be taken in applying these results to present
practice due to the time that has elapsed since the study and evolving treatment
approaches (Dixon et al., 2007).
PREVENTATIVE CARE
One report focused on immunization rates among American Indian elders.
This study examined medical records of 550 urban living American Indians in
Seattle, Washington to evaluate the frequency of influenza and pneumococcal
immunizations received for the 1994-1995 period. Many of the elders reported
multiple co-morbid conditions and poor health and were seen by primary care
practitioners at the Seattle Health Board. Among these elders (65 years and
older), 38% received an influenza vaccine in the last year and 32% were
immunized against pneumonia at some time (Buchwald, Furman, Ashton and
Manson, 2001). This study highlights the need to assess barriers to appropriate
preventive care by American Indian older adults.
Overall, these studies suggest that efforts should be implemented to
improve medication therapy for American Indian elders. However, research
designed to describe medication use patterns and outcomes for American
Indian elders is needed to more specifically identify issues and guide practice
improvements.
FACTORS IMPACTING DISPARITIES IN MEDICATION USE

Race and culture-based health disparities generally refer to the
negative differences in health care access, treatment, and outcomes among
underrepresented minority populations (Institute of Medicine, 2002). While a
comprehensive picture of disparities has been documented for a number of
groups based on race, ethnicity, culture, and socioeconomics, literature is
limited on disparities in health care for the elder American Indian population.
The few studies examining health care aspects for the elder American Indian
population have clearly demonstrated disparities in health for this group
(Sequist et al., 2011).
The health dynamics experienced by American Indians are a function of
their race classification, but more specifically are influenced by mediating

factors that are well-known to cause and exacerbate disparities. These

causal factors are the social determinants of health that include age, gender,
education, socioeconomic status, income, insurance status, geography, and
cultural environment (Sadana, Blas, Budhwani, Koller, and Paraje, 2016;
Marmot and Wilkinson, 2006). The literature is replete with findings
supporting the role of these social determinants in disparities for
underrepresented minority groups including, though not to a great extent, the
American Indian older adult community.
Figure 1. Framework for Medication Use and Causes of Health Disparities in

American Indian Elders.

Medication use is a complex phenomenon, involving a number of issues

that result in inequities for American Indian elders. For the purposes of
this chapter, 25 prescription medication use issues potentially resulting in
health disparities have been identified from the literature and are organized
into six categories: access, social support, patient characteristics, health
beliefs/behaviors, health status, and prescribing behaviors (See Figure 1). The
following is a discussion of the literature available on each of the six
categories impacting disparities focusing on American Indian elders where
information is available and American Indians in general or other minorities
when American Indian elder information is absent.
ACCESS ISSUES
Barriers to access are commonly cited as an issue associated with
prescription medication use. Access in this regard refers to the ability to
consistently procure needed medication. Medication specific access issues
include cost impediments and lack of insurance, structure of the health care
system, and geographic barriers, all of which may result in poor disease
management or suboptimal treatment outcomes (Morgan and Kennedy, 2010;
Sequist et al., 2011).
Funding of Health Care and Cost Impediments
Access to health care services is principally afforded to American Indian

elderly through coverage by Medicare, Medicaid, and IHS (Boccuti et al.,
2014). It is estimated that 96% of American Indian seniors have health care
benefits through Medicare. One fourth of this population claims additional
health coverage through Medicaid. Finally, 23% of American Indian elderly
report added coverage through IHS (Boccuti et al., 2014). It should be noted
that eligibility for IHS coverage requires that a person have documented
membership in one of the 567 federally recognized tribes or be a tribal
descendant (US DHHS, 2016; Boccuti et al., 2014). About 28% of American
Indian seniors report no supplemental coverage through IHS or Medicaid, and
are therefore responsible for out-of-pocket costs not supported by Medicare
(Boccuti et al., 2014).

IHS Organization
An entity of the Department of Health and Human Services, IHS operates

health care services within its own establishments, tribal entities, or in
facilities in urban areas outside of the reservation (Boccuti et al., 2014). The
latter are largely preventive and primary care service providers, known as
Urban Indian Health Programs, which currently include 35 organizations
throughout the United States (Boccuti et al., 2014). IHS exists on an annual
allotment from the federal government and functions as the primary source of
health care funding (80%) for American Indians served by the agency (Boccuti
et al., 2014). Despite what appears to be comprehensive health care coverage
for American Indian elders, many still struggle to access care given coverage
limitations.
Geography/Transportation
Geographic barriers affecting prescription drug therapy include

geographic isolation, travel distance required to procure needed medications,
and transportation challenges that are apparent for elderly American Indians
(Sequist et al., 2011; Boccuti et al., 2014). Geographic isolation, particularly
for reservation-bound elders, is a significant challenge to obtaining needed
health care (Sequist et al., 2011; Boccuti et al., 2014). The same is true
regarding the need to travel long distances to health care facilities and
pharmacies. A study examining geographic challenges to health services
access in 1997 to 1999 found that for American Indians in the Northern Plains
region, the likelihood of accessing health services was predicted by both
distance and altitude of the clinical site (Fortney et al., 2012). A report by the
Kaiser Foundation cited having “no transportation” as one of the top three
barriers to medical care for American Indian seniors (Boccuti et al., 2014).
The disparity in geographic access is demonstrated in a study showing that
11% of American Indian elders reported lack of transportation as a reason for
not seeking medical care within the last year compared to only 1% of the
general US population over 65 years old (Boccuti et al., 2014).

SOCIAL SUPPORT
Caregivers
Informal caregivers play an important role in the care of older American

Indians. An extended family member or members generally takes on this role
in minority groups. This is often true of the American Indian community
where family members are trusted to assume the caregiver role for the elderly
member. These individuals are typically multigenerational with shared cultural
values and beliefs (Goins et al., 2011). The benefits of caregiving such as
spending time with a wise, elderly family member, the pride of caring for
one’s own, and the elder’s appreciation, have been reported to far outweigh
any burden or challenge that might present itself (Jervis, Boland, and
Fickenscher, 2010).
Cultural considerations are important aspects of caregiving. Work by
Knight and Sayegh emphasized how the burden of caregiving is tempered by
cultural values that influence the way in which caregivers deal with stress
(Knight and Sayegh, 2010). In their model of sociocultural stress and coping,
they suggest that social support within the family along with active coping
may be key to both effective caregiving and minimization of caregiver stress
(Knight and Sayegh, 2010). Despite these successful stress management
aspects, poor behaviors by the patient may create challenges for the caregiver
and may result in maltreatment or neglect of the elderly patient or even
retaliatory and negative behavior by the caregiver. This treatment is one of
many issues that is considered elder abuse.
Abuse
Elder abuse within the American Indian community is a product of a

culture wherein norms center on shared resources such as money, food, and
housing. Family members may take advantage of elder members who may
receive the only income among them as recipients of Federal, Social Security
benefits and whose subsidized housing may be the only shelter for generations
of family members. On tribal reservations the problem of elder abuse may be
denied and reporting of abuse poses unique challenges. These difficulties may
create a significant barrier to the elder’s positive sense of well-being (Hendrix,
n.d.).

PATIENT CHARACTERISTICS
Personalized medicine, or more specifically taking a more individualized
approach to medication management, may improve quality of patient care.
Many practitioners agree that this approach is required for older adults who
may be managing an array of chronic diseases and taking regimens that
include many medications (Benetos et al., 2015). Patient characteristics may
influence the etiology of disease, choice of medication by the healthcare
provider, and therapeutic response to a drug.
Genetics and Health Behaviors
Many studies look for causal pathways based on genetic variations in

individuals and populations. This incomplete genomic explanation often leads
to the medical practice of explaining the underpinnings of disease using race
surrogates (Kanakamedala and Haga, 2012). Such was the case for a study
examining African American heart failure patients, which demonstrated a
different response to medications for this population (Taylor et al., 2004).
Similarly, a study examined the etiology of insulin resistance by comparing
Pima Indians in Mexico and the US. In this study personal factors like obesity
and age were cited as reasons for the insulin resistance in lieu of a genetic
explanation (Esparza-Romero et al., 2010).
Socioeconomic
Socioeconomic status is commonly used to explain differences in health

status and treatment outcomes. It is widely known that individuals who are
poor, have limited education, and live in impoverished conditions have worse
outcomes such as disease onset and death at a younger age (Crimmins, Kim,
and Seeman, 2009). Such is the case for many American Indian elders
(Anderson, Bulatao, and Cohen, 2004).
HEALTH BELIEFS/BEHAVIORS
Self-management of disease and illness takes into account an individual’s
personal health beliefs. These beliefs impact a person’s attitudes about his/her

health conditions and resolve to manage them. Such decisions include the
person’s reliance on prescription medication. American Indians exemplify the
effect of health beliefs on medication use especially when those beliefs are at
odds with health care provider recommendations.
Beliefs
One survey study examined 40 members of the Lumbee tribe in North

Carolina and revealed they held strong beliefs about their personal control
over diabetes symptoms (Jacobs, Kemppainen, Taylor, and Hadsell, 2014).
However, many participants felt apathetic and fearful of the potential harms of
the disease, and they sensed a loss of freedom because of the impending
disease effects, level of attention required to manage the disease (e.g.,
adhering to a daily medication regimen, monitoring glucose levels), and
frequent visits to their healthcare provider (Jacobs et al., 2014). A number of
participants admitted to a lack of desire to take the medications, citing
financial reasons. However, many participants stated that they would comply
with treatment because of their belief in the positive effects (Jacobs et al.,
2014).
American Indian beliefs and traditions are the cornerstone of how this
population perceives and maintains health. In American Indian culture, health
and wellbeing are intertwined with spirituality. Healing in this regard
transcends the physical and mental. American Indian tribes pass down stories
and folktales to younger generations to preserve prayers, herbal remedies and
practices such as greeting the early morning with a run to promote a healthy
mind, body and spirit (Koithan and Farrell, 2010).
Traditions
Many traditional practices have been threatened by an increasing desire of

younger generations to adopt more American lifestyles (Koithan and Farrell,
2010). Consequently, the population of American Indians are adhering less to
healthy, plant-based diets and eating more processed and mainstream diets
associated with an American way of life (McLaughlin, 2010). As a result,
diseases like diabetes and cardiovascular disease, once rare among American
Indians, are now commonplace (Koithan and Farrell, 2010).

Senior American Indians, whether on reservations or in urban settings,

struggle to preserve native traditions and may discount or become completely
indifferent to modern health care practices (Kramer, 1992). A study by
Grzywacz et al. (2006) found American Indian elders were twice as likely
as Caucasian Americans to rely on home remedies (Grzywacz et al., 2006).
The choice to select home or folk remedies over Western medicine may
be evidence of this group’s beliefs regarding disease cause, personal
responsibility, and management on the condition (Grzywacz et al., 2006).
There may also be a strong desire to hold on to traditions.
Elderly American Indian patients’ traditional practices may cause
them to believe they are being treated unfairly, subject to stereotypes, or
misunderstood in modern health care settings (Kramer, 1992). Based on the
limited information in this area, it is difficult to draw sweeping conclusions
and, at best, the clinician should be aware of these potential perspectives.
HEALTH STATUS
Many of the factors related to health status have been addressed earlier in
this chapter including the frequency of chronic conditions, medication use
patterns, and longevity.
Perceived Health
Health status takes into account an individual’s personal assessment of

their mental and physical health along with the presence of disease and life
expectancy (Office of Disease Prevention and Health Promotion, 2014). The
health status of older American Indians is often the result of lifestyle aspects
including limited resources, health beliefs, complex disease experiences,
unpredictable health service access, and suboptimal health outcomes (Braun
and LaCounte, 2015).
Patient Characteristics
The presence of multiple health conditions along with disease

complications necessitates polypharmacy or the regular and concomitant use
of two or more drug therapies. Henderson et al. (2006) found a significant

relationship between poor health status and polypharmacy for elder American
Indians (Henderson et al., 2006). In an earlier part of this chapter, geography
was discussed as it related to issues regarding access to medications. There is,
however, another consideration to be made about geography. A study by Moss
and colleagues found that American Indian’s functional disability varied by
region with a higher percentage of American Indians with disabilities being
found in rural areas. Functional disability defines the individual’s ability to
perform daily tasks like medication taking that is necessary for survival (Moss
et al., 2006).
PRESCRIBING BEHAVIORS
Prescribing Process
In medical practice, the provider aims to optimize treatment outcomes

and minimize medication-related problems. This goal may be compromised if
initial medication therapy recommendations are sub-optimal or inappropriate
for the elderly patient. Often times the choice of medications may be correct,
but proper dosing may not occur quickly. It may require several visits to the
practitioner before dosing is manipulated to produce therapeutic relief. Lastly,
therapeutic monitoring by the health care provider must be continuous and
systematic in order for the patient to experience optimal treatment outcomes.
Medication use patterns among American Indian elders were discussed in a
separate section of this chapter.
Clinic Visits
According to a national survey by the Centers for Disease Control,

approximately two-thirds of physician office visits result in medication
therapy (CDC/NCHS, 2012). During such visits medications may be
prescribed, reviewed for appropriateness, or monitored for patient adherence,
therapeutic effectiveness, and adverse effects. Older adults are the largest
consumers of prescription and nonprescription medications (Marek and Antle,
2008). By one account this population is dispensed one-half of all prescription
medications (Pretorius, Gataric, Swedlund, and Miller, 2013).
The aging process often brings about more chronic illness, resulting
in a complex pill regimen that includes multiple medications and several

administration times throughout the day (Marek and Antle, 2008). The
physician visit is, therefore, a vital opportunity to optimize the medication
experience and to be diligent in the process of reducing adverse events that
include medication errors, therapeutic ineffectiveness, medication withdrawal
symptoms and overdose (Pretorius et al., 2013). However, during the clinical
encounter, it is both the physician and the patient who are responsible for
identifying problems and issues in drug therapy.
Shared Accountability
The shared accountability of the patient and provider should result in a

trusted, team approach to medication therapy and overall health care. In
this regard, there must be clarity, openness, and honesty in communications
between the two parties. It is the physician or provider’s responsibility to
recommend and prescribe the most appropriate drug for the patient. The
provider must ensure that the patient understands the purpose of the
medication, the optimal response expected, and potential for unwanted effects.
In turn, the patient must share with the provider concerns about the
medication, any lack of clarity regarding instructions and therapeutic goals,
and be honest about issues of adherence (Matthias et al., 2010).
The propriety of this relationship and the impact of race concordance
(patient and provider) was studied by Schoenthaler and colleagues in a
hypertensive African American sample (Schoenthaler, Allegrante, Chaplin,
and Ogedegbe, 2012). Study findings suggested that race similarities and
differences were not as important as collaborative communication. To date,
only one study was found that evaluated the patient-provider relationship with
American Indians. This study examined the importance of cultural distance
between the patient and provider and suggested that health status assessments
did not appear to be impacted by differences in characterizations as American
Indian but were effected by differences in white characterization (Saha, 2006).
Prescribers
Medication management is dependent on having quality prescribers

available to care for patients. The Indian Health Service has consistently
reported nearly a 20% shortage of prescribers in the form of position
vacancies. Strategies have been implemented to help address this issue (e.g.,

scholarship programs, loan repayment) and evidence of impact will be critical.

(Sequist et al., 2011).
CONCLUSION
Efforts should be focused on optimal medication use practices for
American Indian elders. This population has unique medication needs because
they suffer poorer health (e.g., multiple chronic conditions), greater functional
disability, and a shorter life-span. The available research has shown that
American Indian elders frequently receive polypharmacy (four or more
medications), have twice the odds of receiving a PIM, and often receive
suboptimal therapy for diabetes, lipid management, and asthma. In order to
fully address medication use issues, health disparities must be addressed. This
chapter overviews six categories of issues that may lead to disparities.
However, limited insight is available on these issues due to the dearth of
published studies focused on American Indian elders.
Focused efforts are necessary to optimize the management of disease in
this population. Additional, well designed research is required to create
approaches that best meet the needs of this population.
REFERENCES
Administration for Community Living. (2016). Administration on Aging (AoA)
A statistical profile of older American Indian and Native Alaskans.
Retrieved April 22, 2016, from http://www.aoa.acl.gov/Aging_Statistics/
Minority_Aging/Facts-on-AINA-Elderly2008-plain_format.aspx.
Anderson, N. B., Bulatao, R. A. and Cohen, B. (2004). Critical Perspectives
on Racial and Ethnic Differences in Health in Late Life. Washington, DC:
National Academies Press.
Benetos, A., Rossignol, P., Cherubini, A., Joly, L., Grodzicki, T., Rajkumar,
C., Strandberg, T. E. and Petrovic, M. (2015). Polypharmacy in the aging
patient, Management of hypertension in octogenariancs. JAMA, 314(2),
170-180.
Berger, L., Correa, O. and Sims, Lt J. G. (2010). Identifying Polypharmacy
among older adults using IHS national data warehouse data. The IHS
Primary Care Provider, 35(10), 238-241.

Boccuti, C., Swoope, C. and Artiga, S. (2014). The role of medicare and the
Indian Health Service for American Indians and Alaska Natives: Health,
access, and coverage. Washington DC: Henry J. Kaiser Family
Foundation.
Braun, K. L. and LaCounte, C. (2015). The historic and ongoing issue of
health disparities among Native elders. Generations, posted 02.20.2015.
Retrieved May 2, 2016 from http://www.asaging.org/blog/historic-and-
ongoing-issue-health-disparities-among-native-elders.
Briesacher, B. A., Zhao, Y., Madden, J. M., Zhang, F., Adams, A. S., Tjia, J.,
Ross-Degnan, D., Gurwitz, J. H. and Soumerai, S. B. (2011). Medicare
part D and changes in prescription drug use and cost burden: National
estimates for the medicare population, 2000-2007. Medical Care, 49(9),
834-841.
Buchwald, D., Furman, R., Ashton, S. and Manson, S. (2001). Preventive care
of older urban American Indians and Alaska Natives in primary care.
Journal of General Internal Medicine, 16(4), 257–261.
CDC/NCHS, 2012. (2012). National Ambulatory Medical Care Survey
(NAMCS): 2012 State and National Summary Tables. Atlanta: Center for
Disease Control. Retrieved April 24, 2016, from http://www.cdc.gov/nchs/
data/ahcd/namcs_summary/2012_namcs_web_tables.pdf.
Cooke, C. E., Bresette, J. L. and Khanna, R. (2006). Statin use in American
Indians and Alaska Natives with coronary artery disease. American
Journal of Health-System Pharmacy, 63, 1717-1722.
Crimmins, E. M., Kim, J. K. and Seeman, T. E. (2009). Poverty and biological
risk: The earlier “aging” of the pool. Journal of Gerontology: Medical
Sciences, 64A(2), 286-292.
Dixon, A. E., Yeh, F., Welty, T. K., Rhoades, E. R., Lee, E. T., Howard, B. V.
and Enright, P. L. (2007). Asthma in American Indian adults: The strong
heart study. Chest, 131(5), 1323-1330.
Esparza-Romero, J., Valencia, M. E., Martinez, M. E., Ravussin, E., Schulz, L.
O. and Bennett, P. H. (2010). Differences in insulin resistance in Mexican
and US Pima Indians with normal glucose tolerance. Journal of Clinical
Endocrinology and Metabolism, 95(11), E358-E362.
Fortney, J. C., Kaufman, C. E., Pollio, D., Beals, J., Edlund, C., Novins, D. K.
and The AI-SUPERPFP Team (2012). Geographical access and the
substitution of traditional healing for biomedical services in two American
Indian tribes. Medical Care, 50(10), 877-884.

Goins, R. T. and Pilkerton, C. S (2010). Comorbidity among older American

Indians: The native elder care study. Journal of Cross-Cultural
Gerontology, 25(4), 343-354.
Goins, R. T., Spencer, S. M., McGuire, L. C., Goldberg, J., Wen, Y, and
Henderson, J. A. (2011). Adult caregiving among American Indians: The
role of cultural factors. The Gerontologist, 51(3), 310-320.
Grzywacz, J. G., Arcury, T. A., Bell, R. A., Lang, W., Suerken, C. K., Smith,
S. L. and Quandt, S. A. (2006). Ethnic differences in elders’ home remedy
use: Sociostructural explanations. American Journal of Health Behavior,
30(1), 39-50.
Henderson, J. A., Buchwald, D. and Manson, S. M. (2006). Relationship of
medication use to health-related quality of life among a group of older
American Indians. The Journal of Applied Gerontology, 25(1 suppl), 89S-
104S.
Hendrix, L. R. Ethnogeriatric Curriculum Module: Health and Health Care of
American Indian and Alaska Native Elders. (n.d.) Retrieved April 22,
2016, from http://www.stanford.edu/group/ethnoger/americanindian.html.
Institute of Medicine. (2002). Unequal treatment: What healthcare providers
need to know about racial and ethnic disparities in healthcare. Retrived
April 6, 2016 from http://www.nationalacademies.org/hmd/~/media/Files/
Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-
Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf.
Jacobs, A, Kemppainen, J. K., Taylor, J. S. and Hadsell, C. (2014). Beliefs
about diabetes and medication adherence among Lumbee Indians living in
rural southeastern North Carolina. Journal of Transcultural Nursing,
25(2), 167-175.
Jervis, L. L., Boland, M. E. and Fickenscher, A. (2010) American Indian
family caregivers’ experiences with helping elders. Journal of Cross-
Cultural Gerontology, 25(4), 355-369.
Jervis, L. L., Shore, J., Hutt, E., Manson, S. M. (2007). Suboptimal
pharmacotherapy in a tribal nursing home. Journal of the American
Medical Directors Association, 8, 1-7.
John, R. (1996). Demography of American Indian elders: social, economic,
and health status. In G. D. Sandefur, R. R. Rindfuss, and B. Cohen (Eds.),
Changing numbers, changing needs: American Indian demography and
public health (p. 218). Washington, DC: National Academy Press.
Retrieved from http://www.nap.edu/read/5355/chapter/14.

Kanakamedala, P. and Haga, S. B. (2012). Characterization of clinical study

populations by race and ethnicity in the biomedical literature. Ethnicity
and Disease, 22(1), 96–101.
Knight, B. G. and Sayegh, P. (2010). Cultural values and caregiving: The
updated sociocultural stress and copying model. Journals of Gerontology.
Series B, Psychological Sciences and Social Sciences, 65B(1), 5-13.
Koithan, M. and Farrell, C. (2010). Indigenous Native American healing
traditions. Journal of Nurse Practitioners, 6(6), 477-478.
Kramer, B. (1992). Health and aging of urban American Indians. In. Cross-
cultural medicine: A decade later. Western Journal of Medicine, 157(3),
281-285.
Lamer, C. C., Rowe, J., Barnes, J. and Finke, B. (2005). Evaluation of
medication use in the elderly at the Cherokee Indian hospital using the
beers criteria. The IHS Provider, 30(1), 7-8.
Marek, K. D. and Antle, L. (2008). Medication management of the
community-dwelling older adult. In R. E. Hughes, Patient Safety and
Quality: An Evidence-Based Handbook for Nurses. Rockville (MD):
Agency for Healthcare Research and Quality (US) (p. Chapter 18).
Marmot, M. and Wilkinson, R. G. (2006) Social determinants of health. 2nd
Edition. United States: Oxford University Press.
Matthias, M. S., Parpart, A. L., Nyland, K. A., Huffman, M. A., Stubbs, D. L.,
Sargent, C. and Bair, M. J. (2010). The patient-provider relationship in
chronic pain care: Providers’ perspectives. Pain Medicine, 11, 1688-1697.
McLaughlin, S. (2010). Traditions and diabetes prevention: A healthy plan for
Native Americans. Diabetes Spectrum 23(4), 272-277.
Morgan, S. and Kennedy, J. (2010). Prescription drug accessibility and
affordability in the United States and abroad. The Commonwealth Fund:
Issues in International Health Policy, 1408(89)
Mort, J. R. and Sailor, R. T. (2011). Prescriptions for potentially inappropriate
medications among elderly American indian medicare beneficiaries. The
Annals of Pharmacotherapy, 45, 129-130.
Moss, M. P., Schell, M. C. and Goins, R. T. (2006). Using GIS in a first
national mapping of functional disability among older American Indians
and Alaska natives from the 2000 census. International Journal of Health
Geogrphics, 5(37).
O’Connell, J. M., Wilson, C., Manson, S. M. and Acton, K. J. (2012). The
costs of treating American Indian adults with diabetes within the Indian
Health Service. American Journal of Public Health, 102(2), 301-308.

Office of Disease Prevention and Health Promotion. (2014) Healthy People

2020. General Health Status. Retrieved April 24, 2016, from Healthy
People.gov: https://www.healthypeople.gov/2020/about/foundation-health
-measures/General-Health-Status.
Pretorius, R. W., Gataric, G., Swedlund, S. K. and Miller, J. R. (2013).
Reducing the risk of adverse drug events in older adults. American Family
Physician, 87(5), 331-336.
Quandt, S. A., Bell, R. A., Snively, B. M., Smith, S. L., Stafford, J. M.,
Wetmore, J. K. and Arcury, T. A. (2005). Ethnic disparities in glycemic
control among rural older adults with type 2 diabetes. Ethnicity and
Disease, 15(4), 656-663.
Rianon, N., Knell, M. E., Agbor-Bawa, W., Thelen, J., Burkhardt, C. and
Rasu, R. S. (2015). Persistent nonmalignant pain management using
nonsteroidal anti-inflammatory drugs in older patients and use of
inappropriate adjuvant medications. Drug, Healthcare and Patient Safety,
7, 43–50.
Sadana, R., Blas, E., Budhwani, S., Koller, T. and Paraje, G. (2016). Health
ageing: Raising awareness of inequalities, determinants, and what could
be done to improve health equity. Gerontologist, 56(S2), S178-S193.
Saha, S. (2006). The relevance of cultural distance between patients and
physicians to racial disparities in health care. Journal of General Internal
Medicine, 21(2), 203-205.
Schoenthaler, A., Allegrante, J. P., Chaplin, Wl, and Ogedegbe, G. (2012).
The effect of patient-provider communication on medication aderence in
hypertensive black patients: Does race concordance matter? Annals of
Behavioral Medicine, 43(3), 372-382.
Sequist, T. D., Cullen, T. and Acton, K. J. (2011). Indian Health Service
innovations have helped reduce health disparities affecting American
Indian and Alaska Native people. Health Affairs, 30(10), 1965-1973.
Taylor, A. L., Ziesche, S., Yancy, C., Carson, P., D’Agostino, R., Ferdinand,
K., Taylor, M., Adams, K., Sabolinski, M., Worcel, M. and Cohn, J. N.
(2004). Combination of isosorbide dinitrate and hydralazine in blacks with
heart failure. The New England Journal of Medicine, 351(20), 2049-2057.
US Census Bureau (2014a). Annual estimates of the resident population by
sex, age, race, and hispanic origin for the United States [2014 populations
estimates]. Retrieved from http://factfinder.census.gov/bkmk/table/ 1.0/
en/PEP/2014/PEPASR6H?slice=year~est72014.
US Census Bureau (2014b). Selected population profiles in the United States
[2014 American community survey 1-year estimates]. Retrieved from

http://factfinder.census.gov/bkmk/table/1.0/en/ACS/14_1YR/S0201//popg
roup~009.
US Department of Health and Human Services. (2016). Disparities Fact Sheet.
Retrieved from Indian Health Service: https://www.ihs.gov/newsroom/
factsheets/disparities/.
US Department of Health and Human Services, CDC, National Center
for Health Statistics. (2014). Summary health statistics: National
health interview survey. Age-adjusted precent distribution of respondent-
assessed health status, by seleced characteristics: United States 2014.
Retrived April 14, 2016 from http://ftp.cdc.gov/pub/Health_Statistics/
NCHS/NHIS/SHS/2014_SHS_Table_P-1.pdf.
BIOGRAPHICAL SKETCH
Name: Jane R. Mort, PharmD, FASCP
Affiliation: College of Pharmacy, South Dakota State University
Education:
ASHP Residency Certificate, University of Iowa Hospital and Clinics
PharmD, University of Nebraska Medical Center
Address:
College of Pharmacy
South Dakota State University
Box 2202C
Brookings, SD 57007-0099
Scholarly work is focused on medication use in geropsychiatry, quality

improvement, and teaching. She has provided over 180 presentations at the
state and national level, published more than 110 journal articles/abstracts,
written over 40 newsletter pieces, and received the SDSU 2011 College of
Pharmacy Distinguished Scholar Award.
The following appointments within the College of Pharmacy at South

Dakota State University

Associate Dean for Academic Programs

Coordinator of Assessment
Coordinator for West River Clinical Education
Acting Head of Clinical Pharmacy Department
Professor of Pharmacy Practice (1996-Present)
Associate Professor of Clinical Pharmacy (1991-1996)
Assistant Professor of Clinical Pharmacy (1986-1991)
Honors:
 2011 Distinguished Scholar, College of Pharmacy South Dakota State

University
 College of Pharmacy Faculty Recognition Award for Excellence in
Special Service (2002)
 College of Pharmacy Faculty Recognition Award for Special Service
(2000)
 College of Pharmacy Faculty Recognition Award for Classroom
Teaching (1996)
 College of Pharmacy Faculty Recognition Award for Classroom
Teaching (1993)
 The Upjohn Pharmacy Research Award (1991)
 Rho Chi
PEER REVIEW PUBLICATIONS
1. Hansen DJ, Mort JR, Brandenburger T, Lempola A. Relationship of

prepharmacy repeat course history to students’ early academic difficulty
in a pharmacy curriculum. American Journal of Pharmaceutical
Education 2015;79(10) Article 154.
2. Mort JR. Antipsychotic medication use in nursing homes: Approaches
to reduce use and national trends. South Dakota Medicine 2015;
68(10):464-5.
3. Shiyanbola OO, Mort JR. Patients’ perceived value of pharmacy quality
measures: A mixed-methods study. BMJ Open 2015;5:e006086 doi:
10.1136/bmjopen-2014-006086.

4. Shiyanbola OO, Mort JR. Exploring consumer understanding and

preferences for pharmacy quality information. Pharmacy Practice 2014:
12(4):468-80.
5. Mort JR, Strain JD, Helgeland DL, Seefeldt TM. Perceived impact of a
longitudinal leadership program for all pharmacy students. Innovations
in Pharmacy 2014;5(3):Article 167.
6. Mort JR, Sailor R, Hintz L. Partnership to decrease antipsychotic
medication use in nursing homes. South Dakota Medicine 2014;
67(2):67-9.
7. Strain JD, Farver DK, Heins JR, Mort JR, Shiyanbola OO. Validity and
reliability of a practitioner service tool: Potential resource for assessing
faculty practitioners. American Journal of Health-System Pharmacy
2013;70:1876-8.
8. Shiyanbola OO, Mort JR, Lyons K. Advancing the use of community
pharmacy quality measures: A qualitative study. Journal of the American
Pharmacists Association 2013;53(4):400-407.
9. Mort JR. Involving the resident/decision maker in antipsychotic
medication use. South Dakota Medicine 2013;66(4):148-9.
10. Mort JR, Hintz L. Reducing adverse drug events through the Patient
Safety and Clinical Pharmacy Service Collaborative (PSPC). South
Dakota Pharmacist 2013;27(1):12.
ABSTRACTS
1. Demers S, Van Ede TA, Hansen DJ, Mort JR. A determination of

admissions policies regarding repeat coursework in US pharmacy
schools. American Journal of Pharmaceutical Education 2015;79(5)
Article S4[abstract].
2. Mort JR, Hedge DD. Leveraging sponsor contributions to stimulate
student innovation through a co-curricular leadership award program.
American Journal of Pharmaceutical Education 2015;79(5) Article
S4[abstract].
3. Seefeldt TM, Mort JR. Utilization of a learning management system
for the provision of faculty development. American Journal of
Pharmaceutical Education 2015;79(5) Article S4[abstract].
4. Meyer BA, Mort JR, Fischer JR, Jansen T, Heins JR. Impact of a revised
parenteral product program on students’ proficiency. American Journal
of Pharmaceutical Education 2015;79(5) Article S4[abstract].

5. Farver DK, Mort JR, Arends R, Middendorf AW, Daniel J.

Interprofessional pilot project: PharmD – DNP students’ ambulatory
care telephone simulation. American Journal of Pharmaceutical
Education 2015;79(5) Article S4[abstract].
6. Mort JR, Strain JD, Laible BR, Hedge DD. Leadership development
through required co-curricular experiences – the students’ perspective.
S4[abstract].
7. Mort JR, Seefeldt TM. Dual-purpose accreditation workshop: Enhancing
knowledge while fostering active learning. American Journal of
Pharmaceutical Education 2014;78(5) Article 111[abstract].
8. Mort JR, Seefeldt TM. Use of posters to enhance the accreditation self-
study process. American Journal of Pharmaceutical Education 2014;
78(5) Article 111[abstract].
9. Meyer BA, Mort JR, Jansen T, Heins JR, Fischer JR. Impact of a
parenteral product program on students’ perceived proficiency.
111[abstract].
10. Seefeldt TM, Mort JR, Sayles RA, Brockevelt B, Giger J, Jordre
B, Kattelmann K, Lawler M, Memmott J, Nilson W. Pilot
project comparing interprofessional education via asynchronous online
discussion and synchronous video meeting. American Journal of
Pharmaceutical Education 2014;78(5) Article 111[abstract].
11. Shiyanbola O, Mort J, Harris T, Christensen A. Patient understanding
and preferences for community pharmacy quality measures information.
Journal of the American Pharmacists Association 2014:54(2):e198
[abstract].
12. Shiyanbola O, Mort J, Harris T, Christensen A. Perceived value
of pharmacy quality measures among patients using community
pharmacies. Journal of the American Pharmacists Association 2014;
14(2):e199[abstract].
13. Mort JR, Strain JD, Kappes JA, Farver DK, Heins JR. Pharmacy
Students’ Contribution to Resident Care on a Nursing Home Advanced
Pharmacy Practice Experience. The Consultant Pharmacist 2013;
28(10):644[abstract].
14. Mort JR, Laible BR, Hansen DJ. The hidden map in the IDEA
(individual development and educational assessment) student evaluation
survey process. American Journal of Pharmaceutical Education 2013;
77(5) Article 109[abstract].

15. Mort JR, Jensen Bender W, Heins JR, Jin Z, Messerschmidt K, Rausch
TL, Zhang H. Comparison of faculty protégés’ desired guidance to
guidance provided. American Journal of Pharmaceutical Education
2013;77(5) Article 109[abstract].
16. Hansen DJ, Mort JR, Houglum JE. Identifying risk for academic
difficulties in pharmacy using repeat pre-pharmacy coursework status
and admission rank. American Journal of Pharmaceutical Education
2013;77(5) Article 109[abstract].
17. Shiyanbola OO, Mort JR. Students evaluating students: using online
peer review to assess student pharmacists’ public health projects.
109[abstract].
BIOGRAPHICAL SKETCH
Name: Chamika Hawkins-Taylor
Affiliation: South Dakota State University College of Pharmacy
Education: PhD, Social and Administrative Pharmacy, University of
Minnesota College of Pharmacy
MHA, University of Southern California
BA, Psychology, University of California, Davis
Address: Box 2202C, SAV 149, Brookings, SD 57007
Assistant Professor
January 2015-present
South Dakota State University, Brookings, SD
 Teach and mentor students in the Doctor of Pharmacy Program in the
areas of social and administrative sciences, social epidemiology,
public health, social determinants of health and disparities.
 Conduct mixed methods research in the area of social and
administrative pharmacy and public health.
 Collaborate with faculty, students and College partners on outcomes
research
 Publish research in peer-reviewed publications and pursue relevant
research and scholarship of teaching grant funding.

Professional Appointments: Assistant Professor Pharmacy Practice
Honors:
Rho Chi
Carlson, A. M, C. Hawkins-Taylor, 2016. Social Epidemiology. Chapter in

Social and Behavioral Aspects of Pharmacy Practice. 6th Edition. A.
Wertheimer, N. Rickles, J. Schommer. Boston. Jones and Bartlett.
Forthcoming.
Hawkins-Taylor, C., A. M Carlson 2013. Communication Strategies Must Be
Tailored to a Medication’s Targeted Population: Lessons from the Case of
BiDil, American Health and Drug Benefit, 6(7):401-412.
ABSTRACTS
 Hawkins-Taylor, C., Block, A., Bailey, B., 2016. Pharmacy Practice in
the South Dakota Correctional System: Discovery of an Unconventional
Experiential Practice Site. Anaheim, CA: AACP Annual Meeting, May
23-27, 2016.
 Block, A., Bailey, B., Hawkins-Taylor, C. 2015. Exploring Current
Pharmacist Roles and Attitudes Toward Increased Pharmacy
Involvement in Adult South Dakota State Prisons –WalMart Fellowship
Poster Presented at 25th Annual Pharmacy Research Presentations and
Keo Glidden Smith Fall Pharmacy Convocation

Chapter 5
MENTAL HEALTH DISPARITIES, HISTORICAL

REALITIES, AND SOCIOCULTURAL
BARRIERS OF AMERICAN INDIANS
AND ALASKA NATIVES: A FOCUS ON
SUICIDE PREVALENCE AND PREVENTION
Paula T. McWhirter1, PhD

and Elizabeth Terrazas-Carrillo2,, PhD
University of Oklahoma, TX, US
1
2
Texas A&M International University, TX, US
ABSTRACT
American Indians and Alaska Natives (AI/AN) have experienced
profound sociopolitical and economic hardship, characterized by a history
of colonialism and racial oppression. These experiences have resulted in
higher prevalence rates across a broad range of mental health difficulties,
including depression, posttraumatic stress disorder (PTSD), anxiety,
substance use disorders, and suicide, as compared to the general U.S.
population (Beals et al., 2005; IHS, 2015). In this chapter, we provide a
conceptual overview of the current state of the problem. We begin by

Correspondence concerning this article should be addressed to Elizabeth Terrazas-Carrillo,
Department of Psychology and Communication, Texas A&M International University, 5201
University Blvd., Laredo, TX 78041. E-mail: elizabeth.terrazas@tamiu.edu.

134 Paula T. McWhirter and Elizabeth Terrazas-Carrillo
providing a framework for understanding these mental health disparities,

including discussion regarding interpretations (material vs. psychosocial)
designed to enhance our understanding of this phenomena, followed
by a description of latent, pathway, cumulative and latent effects of
disparities across the lifespan. We then review current research, including
comparisons of lifetime prevalence rates for a variety of mental health
consequences across AI/AN communities. In order to enhance our
understanding of these disparities, we focus on suicidality, which
represents one of the greatest discrepancies experienced among AI/AN
individuals, and the leading cause of death due to mental health
difficulties. Next, we critically examine risk and protective factors known
to impact suicidality and other mental health disparities across AI/AN
communities. This is followed by a discussion of the complex
relationship between risk and protective factors, which provides a
foundation for our recommendations. Finally, we conclude with an
examination of indigenous epistemologies and cultural competence to
prevention and early intervention that promote social justice within these
communities.
INTRODUCTION
In addition to disparities experienced in rates of poverty and mortality
(BJS, 2007; CDC, 2015; IHS, 2015; U.S. Census Bureau, 2015), the most
methodologically rigorous research confirms that AI/AN individuals
experience a disproportionate burden of psychiatric disorders as compared to
the U.S. general population (Gone and Trimble, 2012; Whitbeck, Yu, Johnson,
Hoyt and Walls, 2008). This includes the highest reported lifetime prevalence
rates for depression, posttraumatic stress disorder (PTSD), anxiety, substance
use disorders, and suicide (Beals et al., 2005; IHS, 2015). Particularly
concerning among mental health advocates, suicide rates among AI/AN
individuals are increasing, and recent data indicate suicide deaths at 50%
higher than for non-Hispanic White Americans (Wexler et al., 2015). These
statistics call attention to the complexity of issues involved, and invite an
urgent response in terms of both increased awareness and thoughtful action.
Historical trauma provides a mechanism for increasing awareness
regarding the striking discrepancies found in rates of suicide and other
mental health concerns. Specifically, historical trauma accounts for profound
differences in well-being, which result from an ongoing history of
sociopolitical and economic atrocities, including forced relocation, slavery,
and systematic cultural assimilation, that continue to impact AI/AN

Mental Health Disparities, Historical Realities... 135
communities (Beals, et al., 2005; 2006). The resultant cumulative emotional

and psychological wounding caused by these traumatic experiences,
known as historical trauma, extends over an individual’s lifespan and across
generations. Subsequent trauma further perpetuates a cycle of generational,
familial, and personal trauma, with pervasive consequences to community,
interpersonal, and intrapersonal well-being.
In addition to its other affects, historical trauma contributes to
discrepancies in mental health and well-being through its influence on help
seeking behaviors of AI/AN individuals. As a group, AI/AN populations are
significant less likely to seek out mental health services due to a variety of
reasons, including: (a) lack of trust in mental health interventions and facilities
endorsed by the government or other factions of the dominant culture; (b)
lack of health insurance; and, (c) lack of service provider availability in
geographically isolated communities (Beals et al., 2006). Additionally,
traditional AI/AN healing beliefs may make individuals less likely to seek out
medical or mental health services, and more likely to seek out spiritual healers
within their community (Gone, 2007; Gone and Trimble, 2012). As a result,
those without access to traditional healers or healing methods are unable to
access the assistance that they need to facilitate healing.
In this chapter, we critically examine aspects impacting mental health
disparities among AI/AN communities including economic, geographic, and
cultural factors. Due to the finality of suicide and its direct relationship to a
variety of mental health issues, we place specific emphasis on examining
suicide research and prevention. Following a review of relevant issues, we
conclude with an emphasis on the integration of traditional healing practices
within culturally-sensitive approaches to prevention and early intervention that
promote social justice for these communities.
MENTAL HEALTH DISPARITIES IN CONTEXT

The U.S. Department of Health and Human Services (HHS) defines
mental health disparities as a difference in mental and social well-being that is
linked to social or economic disadvantage (Office of Minority Health, 2010;
2011; Carter-Pokras and Baquet, 2002). The National Institute of Mental
Health (NIMH) defines mental health disparities as differences in incidence,
prevalence, mortality, and burden of disease and mental health conditions
among populations in the U.S. (NIMH, 2016; NIH, 2010). Mental health
disparities are the result of systematic barriers to health, including

discrimination based on ethnicity, religion, gender, socioeconomic status

(SES), sexual orientation, or geographic location. These mental health
inequities are avoidable and unjust, and result from social and economic
systems shaped by access to money, power, and resources (U.S. Commission
on Civil Rights, 2004; Kawachi, Subramanian, and Almeida-Filho, 2002;
Whitehead, 1991). The study of mental health disparities is important because
disadvantaged groups suffer a greater burden of mental illness compared to
other more advantaged populations. These differential burdens among
disadvantaged groups are not accounted for by biological influences; they are
a product of social and economic factors impacting the individual’s
environment (Whitehead, 1991).
The two primary explanations accounting for the existence of mental
health disparities include: 1) the material interpretation, and 2) the
psychosocial interpretation (Kawachi et al., 2002). The material interpretation
suggests mental health disparities are the result of access to resources; thus,
those in lower socioeconomic (SES) brackets have restricted access to food,
shelter, transportation, home ownership, and leisure activities (Lynch, Davey
Smith, Kaplan, and House, 2000). The psychosocial interpretation, focuses on
the effects of stress related to SES. For example, stress associated with
exposure to adverse life circumstances directly affects the body’s physiology
(e.g., allostatic load), but can also indirectly affect the individual by increasing
unhealthy coping behaviors such as smoking and drinking in excess (McEwen
and Seeman, 1999). The literature also differentiates with regard to the impact
of mental health disparities across the lifespan. Three pathways are considered
relevant to mental health disparities across the lifespan: 1) latent effects, 2)
pathway effects, and 3) cumulative effects (Krieger, 2001). Latent effects refer
to the impact of the early environment on adult health (Kuh and Shlomo,
1997). For example, lack of appropriate prenatal care may cause some children
to develop learning deficits later in life. Pathway effects refer to the impact of
the early environment that puts an individual onto a trajectory that affects
health over time (Kuh and Shlomo, 1997). An example is the presence of
early childhood trauma, which may set the individual on a pathway towards
unhealthy relationships and substance abuse later in life. Cumulative effects
refer to the impact of combining intensity and duration of adverse
circumstances, which results in a dose-response effect on health (Hertzman,
1999; Kuh and Shlomo, 1997). In other words, the presence of multiple
adverse situations that are longer-lasting and more intense will have more
profound effects on an individual’s mental health.

MENTAL HEALTH DISPARITIES AMONG AMERICAN

INDIANS/ALASKAN NATIVES
Approximately 5.2 million AI/AN live in the United States, representing
2% of the total population (U.S. Census Bureau, 2015). Most AI/AN live in
Alaska, Oklahoma, New Mexico, South Dakota, and Montana and the tribal
groups with most members include: Cherokee, Navajo, Choctaw, Mexican
American Indian, Chippewa, Sioux, Apache, and Blackfeet (U.S. Census
Bureau, 2015). Mental health disparities are especially prevalent among
AI/AN populations; even though they represent only 2% of the population,
AI/ANs carry a disproportionate burden of mental illness in the U.S. Research
suggests AI/ANs experience serious psychological distress, at about 1.5 to 2.5
times more than the general population, with high rates of depression,
substance use disorders, suicide, anxiety, and PTSD (U.S. Department of
Health and Human Services, 2007).
In spite of a growing need to understand this phenomena, the study of
mental health disparities among AI/ANs has presented unique methodological
challenges for researchers. A recent review of the literature on AI/AN mental
health disparities by Gone and Trimble (2012) found the majority of studies
were limited by small samples, inability to reach tribes located in remote and
geographically isolated communities, linguistic and cultural differences, and
AI/AN suspiciousness of outsiders. One notable exception, the American
Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective
Factors Project (AI-SUPERPFP), represents one of the most comprehensive
attempts to study the mental health of American Indian (AI) communities
(Beals et al., 2003). The sampling strategy and representativeness allowed
researchers to generalize study results to AI populations within the
Southwestern and Northern Plains tribal regions (Gone and Trimble, 2012).
Results revealed remarkably high lifetime prevalence rates of reported mental
disorders both among Northern Plains (44.5%), and Southwestern AIs (41.9%;
Beals et al., 2003). The study further revealed substantial lifetime prevalence
rates for alcohol abuse (Northern Plains, 6.6%; Southern region 9.8%), PTSD
(Northern Plains, 14.2%; Southern region, 16.1%) major depressive disorder
(MDD; Northern Plains, 7.8%; Southern, 10.7%), drug dependence (Northern
Plains, 4.8% and Southern region, 4.0%; Beals et al., 2003). Since the AI-
SUPERPFP was modeled after the National Comorbidity Survey (NCS), it
allowed meaningful comparisons between AI/AN data and data from the
general U.S. population (Kessler et al., 1994).

Another initiative, the Great Smoky Mountains Study, involves a 20-

year longitudinal study including a representative sample of Appalachian
adolescents involving cohorts of individuals who were 13, 11, and 9 years old
when the study began in 1993 (Costello et al., 2010). Now young adults,
preliminary reports indicate high lifetime prevalence rates of psychiatric
disorder (41.7%, 41.3%, 31.4% respectively), alcohol abuse or dependence
(27.9%, 22.1%, and 14.4%), depressive and/or anxiety disorders (6.4%, 5.9%,
5.3%; Costello et al., 1997; 2010). In a related study, Congress mandated
assessment of PTSD among AI/AN Vietnam Veterans through the American
Indian Vietnam Veterans Project (AIVVP; Gone and Trimble, 2012). Results
from this study revealed the highest lifetime prevalence rates for PTSD across
all other ethnic groups of Vietnam veterans (ranging from 45%-57% across
reservations; Beals et al., 2002). Follow up on the AIVVP data revealed
that a history of conduct disorder was correlated with PTSD symptoms,
even after controlling for war zone stress, suggesting consequent deficiencies
in coping skills and emotional regulation secondary to PTSD (Dillard,
Jacobsen, Ramsey, and Manson, 2007). These studies represent the most
methodologically rigorous research conducted with AI/AN populations, and
confirm that AI/ANs experience a disproportionate burden of psychiatric
disorders compared to the U.S. general population (Gone and Trimble, 2012;
Whitbeck, Yu, Johnson, Hoyt and Walls, 2008).
A complex and less cohesive picture emerges when examining research
with clinical and community AI/AN samples. Estimates of prevalence for
mental health disorders exhibit high variability across samples (Gone and
Trimble, 2012). For example, a study of AI/AN adolescents in Midwest U.S.
and Canada found lifetime rates for disorders across the lifespan increased
exponentially between the first wave respondents (when they were 10-12 years
old) and fourth wave respondents (when they were 13-15 years old; Whitebeck
et al., 2008). This reveals an increase in lifetime prevalence of substance use
disorders from 3.2% at wave one to 27.2% at wave four. Similarly, lifetime
prevalence rates for disruptive disorders (e.g., attention deficit/hyperactivity
disorder, oppositional defiant disorder, and conduct disorder) increased
(21.4% to 32.7%), as did the 12-month prevalence rate of MDD (3.2% to
7.8%; Whitbeck et al., 2008). Research with Southwestern adult tribal
members from interrelated families found that about 80% of men and 50% of
women met criteria for a diagnosis of alcohol dependence (Saremi et al.,
2001). Data from the same sample also showed high rates of trauma, sexual
abuse, and binge drinking for these tribal members (Robin et al., 2007; 1997a;
1997b). A study of alcoholism among Mission Indians from reservations in

California found lifetime prevalence rates for alcohol dependence at 66% for
men and 53% for women (Gilder, Wall, and Ehlers, 2004).
Research with AI/AN in clinical settings showed high lifetime prevalence
rates for a range of mental health disorders. For example, Duran et al. (2004)
found that women seeking care at an Indian Health Service (IHS) in New
Mexico reported estimated high lifetime prevalence for MDD (38.2%),
specific phobia (30.7%) alcohol dependence (29.8%) PTSD (29%), and drug
dependence (17.6%; Gone and Trimble, 2012). In spite of inconsistencies
across studies due to sampling differences (e.g., sample size, sampling
strategy, geographic location, or cultural differences), these studies share
similar findings: AI/AN populations experience significantly higher than
average mental disorders as compared to the U.S. general population and other
ethnoracial groups.
SUICIDE AMONG AMERICAN INDIANS/ALASKAN NATIVES

According to the Centers for Disease Control (CDC), AI/ANs have a rate
of suicide twice that of the general population, and it is the second leading
cause of death for AI/AN adolescents and young adults (IHS, 2004; CDC,
2013). Within the AI/AN population, adolescents are the most severely
affected by the increase of suicide (May, 1987; Wexler et al., 2015). Data
collected by the IHS between 2002 and 2004 found that 17.9 per 100,000
AI/ANs committed suicide, which is 1.7 times higher than the U.S. general
rate of suicide of 10.8 per 100,000 (IHS, 2004; Wexler et al., 2015). AI/ANs
ranging in age from 15-24 had a suicide rate prevalence of 34.2 per 100,000,
which is 3.7 times greater than the rate of 9.2 per 100,000 for all races of the
same age bracket (CDC, 2013; IHS, 2004; Wexler et al., 2015). The suicide
rate for AI/AN adults aged 25 to 34 is estimated at 37.5 per 100,000, which is
2.9 times higher than the rate of 12.7 per 100,000 for the general U.S.
population. Among all the areas with high density of AI/ANs, Alaska has the
highest suicide rates, with the Alaska Native Tribal Consortium (ANTC)
reporting 44.5 suicides per 100,000 in the period of 1996-1998 (ANTC, 2001).
It is important to consider the method of measurement when studying
AI/AN suicide. One of the biggest limitations of available research is the fact
that although many American Indians live in urban settings away from
reservations, a bulk of the studies looking at AI/AN suicidal behaviors are
conducted with samples of individuals living on or close to a reservation
(Freedenthal and Stiffman, 2004). This can be a major reason for fluctuating

estimates not only in suicides but attempted suicides and ideations as

well. Although results from a study comparing suicide rates for AI/ANs in
reservations and urban areas yielded similar reported attempts of suicide (14-
18%) for urban and reservation adolescents, urban youth reported higher rates
of psychosocial issues. Perhaps this influenced the lower percentage of
suicidal ideation within the urban youth compared to reservation youth
(Freedenthal and Stiffman, 2004). Also, there are distinctive differences within
tribal communities. Rates can fluctuate from a high of 150 per 100,000 to a
low of 0 per 100,000 across tribes (Van Winkle and May, 1986). Two tribes in
New Mexico demonstrate this phenomena. In 1967, the Apache experienced a
rate of 99.7 suicidal incidence per 100,000 while the Navajo during that same
year encountered suicide in only a 10.3 per 100,000 in its population (Van
Winkle and May, 1986). Thus, it is important to consider community-level
characteristics to understand AI/AN suicide in a socioecological context.
Another barrier to conducting research with AI/AN communities is the
suspicion many AI/ANs have towards non-AI/AN researchers (Wexler et al.,
2015). Indigenous epistemologies differ significantly from Western ideas
about the creation and validation of knowledge. In general, Indigenous
epistemologies emphasize a holistic perspective, while Western science
emphasizes an individual, reductionist approach (Aikenhead and Ogawa,
2007). Moreover, within some indigenous perspectives, language represents
people’s intentions and becomes reality; therefore, from this perspective
talking about suicide may bring suicide to their life (Bodenhorn, 2012; Flora,
2012; Kirmayer, 2012). These differences in the conceptualization, creation,
and transmission of knowledge can result in Westernized approaches to
research alienating the AI/AN communities researchers are trying to study. In
spite of these barriers, socioecologically valid research has found evidence of
risk and protective factors for AI/AN suicide that may be leveraged in
interventions targeting this public health concern.
RISK FACTORS FOR AMERICAN INDIAN/ALASKAN

NATIVE SUICIDE
Research has found evidence of risk factors for AI/AN suicide, including
alcohol and drug use, adverse childhood experiences (ACEs), lower
educational attainment, unemployment, discrimination, and acculturative

stress. These risk factors, however, do not exist in a vacuum; they interact with
other cultural-, community-, and individual-level factors in a complex manner.
Alcohol and drug use. Feelings of alienation and hopelessness have been
associated with AI/AN alcohol consumption and abuse (Johnson and Tomren,
1999). This is concerning because suicidal behaviors often co-occur with
alcohol and drug use among AI/ANs. In fact, studies show that more than half
of AI/ANs exhibited suicidal behavior while they were intoxicated (Alcantara
and Gone, 2007; Barlow, Tingey and Cwik, 2012; May, Serna, Hurt, and
DeBrynn, 2005; Thira, 2014). Many studies exploring factors impacting
suicide among AI/AN communities have documented that individuals who use
alcohol and drugs generally also engage in other risky behaviors and have a
higher likelihood of attempting or completing suicide (Brockie, Dana-Sacco,
Wallen, Wilcox, and Campbell, 2015; Shaughnessy, Doshi, and Jones, 2004;
Wexler et al., 2015; Whitbeck et al., 2008). Research with AI/AN youth has
shown that high levels of alcohol and drug use may be partly a response to
cultural and social isolation experienced in the school setting; AI/AN children
are less likely to have same-race peers unless they attend reservation schools
or schools with high AI/AN population density (Rees, Freng, and Winfree,
2014). In addition, research has shown AI/AN youth are introduced to alcohol
at a younger age by family members rather than peers (Szlemko, Wood, and
Thurman, 2006; Waller, Okamoto, Miles, and Hurdle, 2003). Earlier
introduction to alcohol use has been linked to problem and binge drinking,
especially in mid-adolescence (Frank and Lester, 2002; Henry et al., 2011).
These findings are congruent with recent studies documenting the significant
rates of alcohol and drug use prevalent among AI/AN communities (Beals et
al., 2003; 2006; Costello et al., 1997).
Adverse childhood experiences. These experiences include abuse, neglect,
growing up in a household where parents abused alcohol or drugs or engaged
in domestic violence, had a history of mental illness in the family and/or
incarcerated family members (Anda et al., 2002; Dong et al., 2004; Dube et
al., 2001). In general, AI/ANs have a higher likelihood of experiencing
traumatic and violent events and have the highest rate of violent victimization
of all ethnoracial groups (Manson et al., 2005; Rennison, 2001). Research
suggests that more and longer lasting adverse childhood events are a risk
factor for suicide attempts and other risky behaviors, such as alcohol and drug
use and engaging in delinquent behaviors (Pothoff et al., 1998; Sarche and
Spicer, 2008). For instance, a study of incarcerated AI/AN women revealed
they had a long history of adverse childhood experiences including domestic
violence and sexual abuse by a family member or intimate partner. The same

study found that half of the women in the sample reported seriously
considering suicide in their lifetime, and an estimated 83% of these women
had attempted suicide at least once (De Ravello, Abeita, and Brown, 2008).
Brockie et al. (2015) found that ACEs had a cumulative impact on a host of
negative outcomes; specifically, they found that for every additional ACE
added to their model resulted in increased odds of poly-drug use, PTSD, and
depression.
A history of experiencing or witnessing sexual and physical abuse is also a
significant risk factor for suicide attempts, substance abuse, behavioral, and
relationship problems among AI/ANs (Borowsky et al., 1999). This is another
social issue that permeates AI/AN communities, as AI/AN women are more
likely than women from any other ethnoracial group to report a history of
domestic violence (DV; Bohn, 2003; Kunitz, Levy, McCloskey, and Gabriel,
1998; Rennison, 2001; Tjaden and Thoennes, 2005) and AI/AN children have
higher exposure levels to DV compared to non-AI/AN children (Costello et
al., 1997; Libby et al., 2004). In addition, child abuse and neglect rates are
significantly higher for AI/AN children (13.4 per 1,000) compared to rates for
White children (8.8 per 1,000; HHS, 2014), with some tribes in Alaska and
South Dakota exhibiting the highest rates of child abuse and neglect (99.9 per
1,000 and 61.2 per 1,000 respectively; HHS, 2014). As a result of these
adverse experiences, AI/AN children tend to fall into developmental pathways
that increase their risk of mental illness and substance abuse, which are in turn
risk factors for suicide (Sarche and Spicer, 2008).
Unemployment and economic deprivation. Some research suggests the
recent surge in suicide rates among AI/ANs in the U.S. may be associated with
the recent economic downturn (Sullivan, Annest, Luo, Simon, and Dahlberg,
2013). In fact, the literature shows that higher levels of inequality and low
levels of economic development have been consistently linked to increases in
suicide rates (Luo et al., 2011; Reeves et al., 2012). This is concerning given
that almost a quarter of all AI/ANs live in poverty (28.3%), which is double
the rate of the total U.S. population (15.5%; Macartney, Bishaw, Fontenot,
2013). The median AI/AN household income is $37,227, which is
significantly lower than the median household income for the country
($53,657; U.S. Census Bureau, 2015). Even though the U.S. economy has
recovered in recent years, AI/ANs continue to have higher unemployment
rates compared to the general population (Austin, 2013). AI/ANs have
unemployment rates ranging from 11.3% to 35% in some reservations, which
is much higher than the unemployment rate for the U.S. general population
(Austin, 2013; Sandefur and Liebler, 1997).

Low educational achievement. AI/ANs are less likely to have earned a

high school diploma or GED (82.4% vs. 86.9%) or a bachelor’s degree (13.9%
vs. 43.9%) than the general population (U.S. Census Bureau, 2015). Indeed,
Lanier (2010) found that higher indices of unemployment and poverty among
AI/ANs may result in frustration that can lead to considering suicide a viable
alternative. Quality of education is also a significant concern, as it influences
the aspirations and goals of many AI/ANs. A higher quality of education may
equip people for more stable occupations and can have an effect over
increasing standards of living. However, AI/AN schools continue to lag behind
those of the U.S. general population, with average scores for AI/ANs on
annual educational school assessments in reading and math falling
significantly lower than their White counterparts from kindergarten to first
grade, and higher than average dropout rates (Nelson, Greenough, and Sage,
2009). For example, in 2007 the AI/AN achievement gap in fourth grade
reading was 18 percentage points compared to the general population and the
achievement gap in fourth grade math was 12 percentage points compared to
the general population (Nelson, et al., 2009).
Acculturative stress and discrimination. The majority of the AI/AN
population has been shifting from rural to more urban areas of the country.
Although approximately 63% of AI/ANs live off the reservations, they
continue to live relatively near the reservations and are mostly concentrated
in the Western portion of the United States (May, 1987). This tendency
toward urbanization has directly accompanied increases in suicide incidences
of young tribal members (Freedenthal and Stiffman, 2004; Novins et al.,
1999). Statistics confirm that AI/AN teens who are more acculturated into
mainstream of American society are more susceptible to suicide than those
with strong tribal ties and values (Kirmayer, Fletcher, and Boothroyd, 1997;
LaFromboise, Coleman and Gerton, 1993). Ethnic identity is defined as
possessing cultural knowledge, self-labeling as a member of the ethnic group,
and being involved in group activities (Cokley, 2007), and it has been found
that low levels of ethnic identity among AI/ANs are related to low self-esteem
and decreased resiliency in the face of stressful events (Jones and Galliher,
2007; Kral, Idlout, Minore, Dyck, and Kirmayer, 2011; Rieckmann,
Wadsworth, and Deyhle, 2004).
Discrimination is also experienced regularly by peoples of disadvantaged
social status, including AI/ANs (Kessler, Mickelson and Williams,
1999). Much research has established the detrimental effects of perceived
discrimination on health and mental health (Taylor and Turner, 2002;
Whitbeck, Hoyt, McMorris, Chen, and Stubben, 2001; Williams, Neighbors

and Jackson, 2003). More alarmingly, perceived discrimination has been

associated with anger, aggression, depression, suicidal behavior, and early
onset substance use (Freedenthal and Stiffman, 2004; Walls, Chapple and
Johnson, 2007; Whitbeck, McMorries, Hoyt, Stubben and LaFromboise, 2002;
Whitbeck et al., 2001). Moreover, AI/ANs living in reservations also
experience discrimination from neighboring communities, which impacts
identity development among AI/AN children and youth (Moore, 2006).
Hartshorn, Whitbeck and Hoyt (2012) found that perceived discrimination
is associated with later anger and aggression, establishing a temporal
link between these two variables. In addition, the effects of perceived
discrimination were found to be cumulative, with more experiences of
discrimination being linked to increased levels of anger and aggressive
behaviors among youth in a sample of indigenous adolescents from Northern
U.S. and Canada (Hartshorn, et al., 2012).
Historical trauma. As previously mentioned, historical loss or trauma is
defined as the “cumulative emotional and psychological wounding across
generations, including the lifespan, which emanates from massive group
trauma” (Brave Heart et al., 2011, p. 283). Group trauma is rooted in the
history of ethnic cleansing and colonization of AI/ANs resulting from
European contact, and the subsequent mandated policies of forced
acculturation among AI/ANs who survived (Brave Heart and DeBruyn, 1998).
Brave Heart and DeBruyn (1998) allude to a “cultural genocide,” which
resulted in threatening the integrity and viability of AI/AN communities
through displacement, domination, and exploration. Displacement from the
land was a significant source of grief for AI/ANs, as most indigenous
traditions consider land, plants, and animals as sacred relatives and equally
important entities in the universe (Brave Heart and DeBruyn, 1998; Gone
and Trimble, 2012). Moreover, the decreeing of forced assimilation by
mandating AI/AN children to attend boarding schools intensified a sense of
discrimination, loss, and racism. Children in these boarding schools were
punished for dressing in traditional ways or speaking their native languages
and in many instances they were removed from their families, disrupting their
sense of community (Brave Heart and DeBruyn, 1998; Gone and Trimble,
2012). The main perpetrator of these genocidal acts was the federal
government, which means that AI/ANs continue to live alongside the
perpetrators of these acts and are continuously reminded of their status as
vulnerable minorities (Brave Heart and DeBruyn, 1998; Duran and Duran,
1995).

The trauma experienced by AI/AN communities is present across

generations, as younger AI/ANs experience a sense of pain and anger linked to
what happened to their ancestors (Brave Heart and DeBruyn, 1998; Duran and
Duran, 1995). For instance, Whitbeck, Chen, Hoyt, and Adams (2004) found
that higher levels of historical loss were linked to higher levels of anxiety,
depression, and anger among young AI/ANs. A study of indigenous peoples in
Canada found that having a parent or relative who attended boarding school
was related to a history of abuse and suicidal thoughts and attempts (Elias,
Mignone, Hall, Hong, Hart, and Sareen, 2012). In providing testimony to the
U.S. Congress about the causes of health disparities among AI/ANs, Michael
Bird, the Executive Director of the National Native American AIDS
Prevention Center stated “when you dispossess people of their land or labor,
their culture, their language, their tradition, and their religion you set into force
powerful forces that impact [people] in a very negative and adverse way”
(U.S. Commission on Civil Rights, 2004, p. 14). Historical trauma for
contemporary AI/ANs is also compounded by exposure to trauma resulting
from adverse childhood environments, violent victimization, child abuse and
neglect, parental incarceration or mental illness, and suicide in their
communities (Brave Heart et al., 2011).
Data regarding suicidal behaviors among culturally distinct tribes – the
Pueblo, Southwest, and Northern Plains tribes showed that each correlate of
suicidal ideation unique within the social structure of each tribe (Novins, et al.,
1999). Suicidal ideations also correlated with the presence or strength of each
tribe’s support systems and beliefs about individuality, gender roles, and death
(Novins et. al, 1999). Thus, in order to fully understand suicide among AI/AN
communities, it is also necessary to understand the impact of protective factors
against suicide for this population.
PROTECTIVE FACTORS FOR AMERICAN INDIAN/ALASKAN

NATIVE SUICIDE
Scholars have expressed a concern that much of the research on AI/AN
populations is focused on deficits, psychopathology, and identifying problems
without giving consideration to resiliency, coping, and adaptive strategies
(LaFromboise and Dizon, 2003; Wexler et al., 2015). Research has found that
for AI/ANs, protective factors have a buffering effect through their interaction
with risk factors and contribute independently to decreasing suicide and

suicide attempts (Mackin, Perkins, and Furrer, 2012). In fact, adding or

enhancing protective factors was more effective in preventing AI/AN suicide
than decreasing risk factors since they seem to act independently of risk
factors (Borowsky et al., 1999).
The family network. Most AI/AN research points to the family and
extended family networks as a source of strength for AI/AN communities, as
they emphasize interdependence and reciprocity (Bearinger et al., 2005;
Cummins, Ireland, Resnick, and Blum, 1999; LaFromboise, Trimble, and
Mohatt, 1993). For example, family involvement in traditional ceremonies and
other cultural values has been associated with lower rates of substance abuse,
violence, and alienation (Stubben, 1997; Thurman and Green, 1997).
Moreover, a strong family orientation may be protective against the impacts of
discrimination and acculturative stress (Garwick and Auger, 2000; Harris,
Page, and Begay, 1988). Another identified strength in AI/AN families is a
strong relationship with elders, from whom parents and families may seek
assistance or counsel (Joe and Malach, 1992). Studies have shown that a
family’s relationship with elders is linked with increased resiliency (Johnson,
1995; House, Stiffman and Brown, 2006).
Cultural embeddedness. The level of embeddedness in a culture is
manifested by the extent to which the individual participates in cultural
traditions and through self-reported cultural identity; this is called
enculturation (Whitbeck et al., 2004). Emphasis on following traditional
AI/AN ways has received attention from many AI/ANs as a way to strengthen
their communities (Goodluck and Willeto, 2001; Stubben, 1997). However,
this strategy has received mixed support in the research literature. Some
studies show engagement in traditional practices is protective of suicide and
mental illness (Garroutte et al., 2003) and decreased rates of substance use
(Thurman and Green, 1997; Yu and Stiffman, 2010), but other studies show
participation in traditional practices is linked to increased substance abuse
(Hawkins et al., 2004; Mail, Heurtin-Robers, Martin, and Howard, 2002;
Petoskey, Van Stelle and De Jong, 1998; Yu, Stiffman, and Freedenthal, 2005;
Stiffman et al., 2007). There is a complex relationship of enculturation to
substance abuse due to the collectivistic orientation of AI/AN, as the
individual’s sense of identity is tied to the group (Whitbeck et al., 2004). As a
result, if the community perceives negative or discriminatory society attitudes
towards their culture and ethnic heritage, then the individual will be reminded
of his status in the larger cultural hierarchy. While enculturation can be
protective against suicide and substance abuse, its effects are limited and
mediated by levels of historical loss; in general, those who are more

enculturated tend to also report higher levels of historical loss (Whitbeck et al.,
2004).
Community orientation. Most research on suicide protective factors in
AI/AN communities has focused on the individual. However, indigenous
peoples believe that the person is only one entity in a universe full of other
entities and powerful sources of knowledge (Kirmayer et al., 2011). As a result
of this collectivistic orientation, evidence suggests that AI/AN communities
with more political engagement, community institutions, and cultural
continuity report lower levels of suicide (Chandler and Lalonde, 1998; Kral
and Idlout, 2009; Wexler et al., 2015). Chandler and Lalonde (1998) found
that levels of political engagement, cultural facilities, and overall services were
negatively correlated with suicide rates per tribe. In other words, the less
cultural continuity measured by the existence of these cultural and community
entities, the higher the rates of suicide for that tribe. In another study using a
contextual and socioecologically relevant framework, researchers found that
community level factors explained most of the variance in suicide outcomes
among Alaskan Native youth (Allen et al., 2014). Overall, many of the
strengths of AI/ANs are grounded in cultural values that have persisted
through both current and past adversity (Kirmayer et al., 2011).
THE COMPLEX RELATIONSHIP BETWEEN RISK AND

PROTECTIVE FACTORS FOR SUICIDE AMONG AI/ANS
Mackin et al., (2012) found evidence for a cumulative risk/protective
model for suicide. The authors concluded that for every additional risk factor
present in an AI/AN youth’s life, there is a 1.4 increase on the likelihood of
attempting suicide, and presence of one protective factor decreases likelihood
of attempting suicide by 50%. In addition, Mackin et al., (2012) concluded that
protective factors are more significantly impactful for youth who reported
higher levels of risk, thereby providing a buffering effect through their
interaction with risk factors. Their study also showed that protective factors
contribute independently to decreasing suicide and suicide attempts (Mackin et
al., 2012). Another study found that adding or enhancing protective factors
was actually more effective in preventing AI/AN suicide than decreasing risk
factors because they act independently of risk factors (Borowsky et al., 1999).
In their study, Borowsky et al., (1999) found that increasing protective factors
like discussing problems with friends and family, fostering emotional health

and well-being, and family connectedness was significantly more effective at

reducing the risk of suicide than attempting to remove any of the risk factors
present in their study.
Overall, while there is much advance in the field of researching risk and
protective factors related to suicide among AI/AN communities, the reality is
that their relationships and interactions to individual- and community-level
factors are complex and shaped by context. Much research is still needed to
explore these relationships across a variety of tribes and through different
contexts. Nonetheless, knowledge of these risk and protective factors can be
important for the creation of specific interventions for AI/ANs, as well as to
strategically remove barriers to accessing services needed to overcome these
mental health disparities.
FACTORS CONTRIBUTING TO MENTAL

HEALTH DISPARITIES
While the causes of health disparities are complex, there are known
factors influencing mental health outcomes for AI/ANs. Racial bias and
discrimination can and do impact several of these factors at several levels,
from the individual to the systemic level (U.S. Commission on Civil Rights,
2004). Factors identified as impacting health disparities include: 1) limited
access to health facilities and providers, 2) limited access to health insurance,
3) insufficient federal funding, and 4) quality of care issues (U.S. Commission
on Civil Rights, 2004). These factors usually overlap and compound the
challenges to overcoming mental health disparities.
Limited access to health facilities and providers. This factor alludes to the
limited number of accessible mental health care institutions and staff that
provide much needed services to AI/ANs (U.S. Commission on Civil Rights,
2004; Gone and Trimble, 2012). Many AI/ANs live in reservations or
communities that are geographically isolated with inaccessible roads during
certain times of the year and must travel great distances to access medical
facilities and providers (U.S. Commission on Civil Rights, 2004). Many
examples of the pervasive impact of this lack of accessibility to services were
provided in the testimony to the U.S. Congress regarding health care
disparities among AI/AN communities (U.S. Commission on Civil Rights,
2004). For example, the Cheyenne River Sioux tribe’s nearest obstetrics
facility is located 90 miles away with reports of multiple childbirths happening

during the ambulance ride, and for the Kalispel in Washington there are no
primary medical health services available in a 75 mile radius (U.S.
Commission on Civil Rights, 2004).
Limited access to health insurance. It is estimated that only 36% of
AI/ANs have access to employment-sponsored health insurance, compared to
an estimated 62% of White Americans (Kaiser Family Foundation, 2013). This
gap is largely due to high levels of unemployment among AI/ANs (KFF,
2013). While Medicaid fills this gap and provides funding for IHS by covering
1 in 3 AI/ANs, an estimated 30% of AI/ANs remain uninsured (KFF, 2013). A
major factor preventing AI/ANs from enrolling in public insurance programs
is their unique relationship with the government, which entitles them to
receive health care (U.S. Commission on Civil Rights, 2004). Many AI/ANs
believe participation in public insurance programs may result in elimination of
the IHS, and believe healthcare should be provided by the federal government
given their agreement to cede millions of acres of land through many treaties
to the U.S. government (U.S. Commission on Civil Rights, 2004; KFF, 2013).
Although the Affordable Care Act (ACA) had a provision allowing Medicaid
expansion that could potentially help 9 in 10 AI/ANs, it is up to individual
states whether to move forward with it (KFF, 2013). The Kaiser Family
Foundation (2013) estimates that AI/ANs will remain uninsured in states not
moving forward with Medicaid expansion since many would not qualify for
tax credit subsidies to purchase insurance in the marketplaces. Other barriers
to enrollment in public insurance programs include lack of knowledge about
program availability, difficulty navigating the enrollment process, literacy,
geographic and transportation barriers (KFF, 2013; U.S. Commission on Civil
Rights, 2004).
Insufficient federal funding for IHS. Approximately 55% of all AI/ANs
rely on the IHS for their mental health care needs, especially if they live in or
nearby reservations (IHS, 2015). However, many AI/ANs living in urban
settings away from reservations have to rely on mainstream mental health
systems (Gone and Trimble, 2012). Thus, there is a large proportion of
AI/ANs encountering barriers to access IHS-funded mental health services.
Another barrier to access stems from the limited funding appropriated by the
federal government to the IHS, which results in rationing of services to
AI/ANs (Gone and Trimble, 2012; U.S. Commission on Civil Rights, 2003).
The IHS is a discretionary program, which means funding must be
appropriated each year by the U.S. Congress (U.S. Commission on Civil
Rights, 2003). If the need for services exceeds available funding, then health
care services are rationed, prioritizing preventive health and direct health

services over all other needs (KFF, 2013). For example, the IHS spends $2,741
per capita, while the expenditure per capita for the general population is
$6,909 (Gone and Trimble, 2012; IHS, 2011a). Unfortunately, the outlook for
mental health care expenditures is not better off, as it is estimated that about
10% of funds allocated per capita are channeled to mental health services
(Gone and Trimble, 2012; IHS, 2011b).
Quality of care issues. These issues include the availability of qualified
providers who can deliver services in a culturally responsive manner (U.S.
Commission on Civil Rights, 2004). A major challenge to maintaining high
standards of quality mental health care is to recruit and retain competent
personnel, yet historically the IHS has had high staff turnover (U.S.
Commission on Civil Rights, 2004). Many mental health care providers
working at the IHS are not AI/ANs and often depart after a few years.
Although the educational loan repayment for healthcare professionals has
improved the available pool of service providers in AI/AN communities, many
of these professionals leave once they have fulfilled their commitments (Gone
and Trimble, 2012). Another important aspect to maintaining high quality of
care among mental health practitioners is their ability to provide culturally
competent services to AI/ANs. A landmark study by Sue, Allen, and Conaway
(1978) showed that AI/ANs did not traditionally use mental health services,
and among those who did, 55% did not return for a second session.
Researchers attribute the underutilization of mental health services among
AI/ANs to negative attitudes to non-AI/AN clinicians, who may not appreciate
the cultural and socioecological complexities of their emotional problems
(Manson and Trimble, 1982; Sue, 1977; Shoenfeld, Lyerly, and Miller, 1971).
Often, mental health care provided is geared toward those who understand and
relate easily to Anglo culture. In addition, it is difficult for American Indians
to relate to social workers, counselors, and psychologists who interact
differently than what is culturally acceptable for American Indians (Gone,
2004). For example, AI/ANs see mind, body, spirit, and nature in a holistic
way, which means there is little separation between everyday life, religion,
medicine, and health. However, this is not usually how mental health providers
conceptualize treatment services, as they often focus on addressing only one
domain of the person’s life (Heinrich, Corbine, and Thomas, 1990;
Lafromboise and Bigfoot, 1988). Many AI/ANs do not trust Anglo mental
health workers. They often assume that White social workers, counselors, and
psychologists are not sensitive to their cultural ways and interactions (Manson
and Trimble, 1982; Gone, 2004). Not many AI/ANs are trained in psychology.
This poses a large problem for the IHS-provided mental health services, which

are largely staffed with Anglo workers. Thus, mental health services provided
are often ineffective as they fail to understand cultural beliefs and to meet
AI/AN’s real needs (Gone and Trimble, 2012).
Cultural competence has been emphasized as a way to adapt clinical
services to treat AI/AN in a respectful, sensitive way by skilled clinicians
(Sue, Zane, Hall, and Berger, 2009). Multicultural psychology focuses on
clinician competence in the areas of knowledge, skills, and awareness of
cultural issues (Sue, 2001). However, there is no empirical evidence
supporting the contention that cultural competence can increase the efficacy of
mental health treatment for AI/ANs. In fact, some AI/AN scholars warn
against fostering an essentialist view that reduces a cultural group to a list of
facts and figures without properly understanding intragroup diversity and
individual tribe traditions, beliefs, and values (Lakes, Lopez, and Garro, 2006;
Waldram, 2004). Moreover, cultural competence focuses on enhancing the
clinician’s skills to adapt mainstream therapeutic approaches to AI/AN
populations without taking into consideration the deep epistemological
differences between AI/AN and Western views of life and existence (Gone,
2008). In fact, Wendt and Gone (2011) strongly advocate towards a move
towards developing culturally sensitive treatments rather than emphasizing
training of culturally competent therapists.
CONCLUSION
The complexity of mental health disparities among AI/ANs cannot be
understated. There are many sociodemographic factors that put AI/ANs at risk
for mental illness and suicide: alcohol and substance use, adverse childhood
experiences, unemployment and economic deprivation, low educational
achievement, discrimination, and historical trauma. Research has linked each
one of these factors independently to a host of mental disorders ranging from
depression to PTSD and substance abuse across AI/AN tribes and in distinct
geographic locations. These risk factors are compounded by the realities of
limited availability of mental health care for geographically isolated tribes,
limited access to insurance, insufficient federal funding provided for the IHS,
and poor quality of care provided in their facilities. These issues are systemic,
yet most efforts to effect mental health disparities among AI/ANs have
focused on only a few factors. For example, simply increasing funding to the
IHS will not significantly lower the prevalence of mental illness among AI/AN
communities. Any efforts to decrease mental health disparities in AI/AN

communities has to be multipronged, multidimensional, and involve multiple

stakeholders.
There is, however, hope that AI/AN protective factors such as the
importance and centrality of the family and community networks and cultural
embeddedness can be leveraged to decrease prevalence of mental illness and
suicide in AI/AN communities. This possibility is especially encouraging
given research findings linking the presence of protective factors to a
decreased prevalence of suicide and mental illness independently of effecting
risk factors. In fact, promising studies show it is more efficacious to focus
intervention on augmenting protective factors rather than decreasing risk
factors for suicide and mental illness. In spite of these significant advances in
research, the pace at which this knowledge is integrated into empirically-
validated prevention programs and treatments for AI/ANs continues to be
slow.
RECOMMENDATIONS
An important aspect of creating, translating, and adapting prevention and
intervention programs is through collaborations with Indigenous communities
to establish relationships that can provide immediate and local benefits.
However, AI/AN communities are unlikely to enter into research collaboration
with mental healthcare providers espousing a traditional Western epistemology
regarding mental health and well-being. Wexler et al., (2015) conceptualize
collaborations between researchers and AI/AN communities as opportunities to
start an emancipatory process leading to solutions that reflect the community’s
own priorities, needs, beliefs, and practices (Caldwell et al., 2005; Smith, 1999;
Wallerstein and Duran, 2006). Moreover, these research collaborations can
successfully address issues of sustainability of prevention and intervention
efforts beyond research. In other words, it is important for researchers and
AI/AN communities to collaborate to ensure the interventions and treatments
continue to be implemented after the research is completed and researchers
leave. In addition, funding agencies continue to issue directives about questions
they are interested in addressing with minority populations, which limits
researchers to only a specific set of research questions viable for funding
(Wexler et al., 2015). For example, the NIH is moving towards investigating
neurobiological bases of mental illness, which may deemphasize cultural factors
in favor of generalizable biological mechanisms of action. An emphasis on
maximizing internal validity through experimental and quasi-experimental

designs designed to demonstrate efficacy of treatments often minimizes the role

of culture and context. Wexler and colleagues (2015) argue that mental health
research using qualitative methods allows for greater depth and context to gain
insight about AI/AN understandings of mental health and well-being. However,
small qualitative studies rarely get funded. These circumstances, coupled with
the demanding timelines usually aligned to funding agencies’ research agendas
may deter researchers from engaging in the degree of involvement and
relationship-building efforts required to create true research collaborations with
Indigenous Peoples.
Another recommendation to further decrease mental health disparities
among AI/AN communities involves exploring interactions of risk and
protective factors known to impact prevalence of mental illness across
individual- and community-levels. In other words, rather than conceptualizing
mental illness and suicide as individual problems, these should be
conceptualized as a community-wide social problem influenced by many
community-level factors. Recent studies have found that risk and protective
factors of suicide and mental illness among AI/AN communities have complex
relationships and may be augmented or decreased independently based on
context. Specifically, different tribes may have different contextual and
protective/risk factors interacting in unique ways. Yet most research including
AI/ANs traditionally aggregates all individuals under the AI/AN identification
without looking at specific tribal and cultural differences.
While researching risk factors for mental illness and suicide is an
important endeavor, it is important also to leverage protective factors already
present within the AI/AN communities. This is especially important in light
of research findings showing that protective factors against suicide and a
host of mental illnesses act independently of risk factors. In addition,
leveraging protective factors is an important aspect of treatment and prevention
development for AI/AN communities, as they value a holistic perspective
towards understanding health and well-being. Although cultural embeddedness’
impact on mental health and suicide was mediated by the experiences of
discrimination, it is possible that promoting healing from a culturally-congruent
standpoint can lead to increased well-being through embracing the AI/AN rich
heritage. This possibility, however, can only be possible by enhancing
community resilience and development, rather than focusing only on individual
resiliency.
Further policy recommendations to decrease and eliminate mental health
disparities should involve removing access barriers to mental health care among
AI/AN communities. This specific recommendation can be achieved through

many avenues including: 1) increasing funding for the IHS, 2) increasing the
number of mental health contractors able to provide services to AI/ANs in urban
settings and/or geographically isolated communities, 3) promote availability of
crisis hotlines that can be accessed by anyone, and ensure staff providing crisis
hotline services are trained on important AI/AN cultural considerations
regarding suicide and mental illness, 4) foster cultural competence of mental
health care providers serving AI/AN by offering opportunities for training and
professional development, and 5) increase access to insurance funding by
accessing extended Medicaid benefits offered through ACA. In conclusion,
regardless of next steps, recommendations necessarily include a focus on
traditional wellness values and beliefs, with an integration of culturally grounded
healing practices.
In this chapter, we provided an overview of current mental health
disparities experienced by AI/NA communities, with a discussion of
contributing factors ranging from historical trauma and adverse childhood
experiences, to discrimination and economic factors limiting access. Our
discussion of suicidality, a primary indicator of health and wellness, centered
on the complex relationship between risk and protective factors, and the
importance of addressing wellness through a lens of cultural resiliency. We
hope the information provided will contribute to enhanced awareness and
meaningful action toward a socially just response.
REFERENCES
Aikenhead, G.S. and Ogawa, M. (2007). Indigenous knowledge and science
revisited. Cultural Studies of Science and Education, 2(3), 539-620.
Alaska Native Tribal Health Consortium (2001). Alaska Native mortality:
1980-1998. Anchorage, AK: Alaska Native Tribal Health Consortium.
Retrieved from: http://www.inchr.com/Doc/February05/mortality-98-
report.pdf.
Alcantara, C. and Gone, J.P. (2007). Reviewing suicide in Native American
communities: Situating risk and protective factors within a transactional-
ecological framework. Death Studies, 31, 457-477.
Allen, J., Mohatt, G.V., Fok, C.C.T., Henry, D., Burkett, R. and People
Awakening Team (2014). A protective factors model for alcohol abuse
and suicide prevention among Alaska Native youth. American Journal of
Community Psychology, 54, 125-139.

Anda, R.F., Whitfield, C.L., Felitti, V.J., Chapman, D., Edwards, V.J., Dube,
S.R. and Williamson, D.F. (2002). Adverse childhood experiences,
alcoholic parents, and later risk of alcoholism and depression. Psychiatric
services, 53, 1001-1009.
Austin, S. (2013). High unemployment means Native Americans are still
waiting for an economic recovery. Washington, DC: Economic Policy
Institute, Issue Brief 372. Retrieved from: http://www.epi.org/publication/
high-unemployment-means-native-americans/.
Barlow, A., Tingey, L., Cwik, M., Goklish, N., Larzelere-Hinton, F., Lee, A.,
Suttle, R., Mullany, B. and Walkup, J.T. (2012). Understanding the
relationship between substance use and self-injury in American Indian
youth. American Journal of Drug and Alcohol Abuse, 38, 403-408.
Beals, J., Manson, S.M., Mitchell, C.M., Spicer, P., AI-SUPERPFP Team
(2003). Cultural specificity and comparison in psychiatric epidemiology:
Walking the tightrope in American Indian research. Culture, Medicine,
and Psychiatry, 27, 259-289.
Beals, J., Manson, S.M., Shore, J.H., Friedman, M., Ashcraft, M., Fairbank,
J.A. and Schlenger, W.E. (2002). The prevalence of posttraumatic stress
disorder among American Indian Vietnam veterans: Disparities and
context. Journal of Traumatic Stress, 15, 89-97.
Beals, J., Novins, D.K., Spicer, P., Mitchell, C.M., Manson, S.M. (2005).
Prevalence of mental disorders and utilization of mental health services in
two American Indian reservation populations: Mental health disparities in
a national context. American Journal of Psychiatry, 162, 1723-1732.
Beals, J., Novins, D.K., Spicer, P., Whitesell, N.R., Mitchell, C.M., Mitchell,
C.M., Manson, S.M. (2006). Help seeking for substance use problems in
two American Indian reservation populations. Psychiatric Services, 57,
512-520.
Bearinger, L.H., Pettingell, M.D., Resnick, M.D., Skay, C.L., Potthoff, S.J.
and Eichhorn, J. (2005). Violence perpetration among Urban American
Indian youth: Can protection offset risk? Archives of Pediatrics and
Adolescent Medicine, 159, 270-277.
Bodenhorn, B. (2012). Meeting minds, encountering worlds: Sciences and
other expertises on the north slope of Alaska. In M. Konrad (Ed.),
Collaborators collaborating: Counterparts in anthropological knowledge
and international research relations (pp. 233-252). New York, NY:
Berghahn.

Bohn, D.K. (2003). Lifetime physical and sexual abuse, substance abuse,
depression, and suicide attempts among Native American women. Issues
in Mental Health Nursing, 24, 233-352.
Borowsky, I.W., Resnick, M.D., Ireland, M. and Blum, R.W. (1999). Suicide
attempts among American Indian and Alaskan Native youth: Risk and
protective factors. Achives of Pediatric and Adolescent Medicine, 153,
573-580.
Brave Heart, M.Y.H, Chase, J., Elkins, J. and Altshul, D.B. (2011). Historical
trauma among Indigenous Peoples of the Americas: Concepts, research,
and clinical considerations. Journal of Psychoactive Drugs, 43, 282-290.
Brave Heart, M.Y.H. and DeBruyn, L. (1998). The American Indian
Holocaust: Healing historical unresolved grief. American Indian and
Alaska Native Mental Health Research, 8, 56-78.
Brockie, T.N., Dana-Sacco, G., Wallen, G.R., Wilcox, H.C. and Campbell,
J.C. (2015). The relationship of adverse childhood experiences to PTSD,
depression, poly-drug use and suicide attempt in reservation-based Native
American adolescents and young adults. American Journal of Community
Psychology, 55, 411-421.
Bureau of Justice Statistics (2007). Victims’ characteristics: Race/ethnicity.
Retrieved from: http://www.bjs.gov/index.cfm?ty=tp&tid=922.
Caldwell, J.Y., Davis, J.D., DuBois, B., Echo-Hawk, H., Erickson, J.S.,
Goins, R.T., Hill, C.,… and Stone, J.B. (2005). Culturally competent
research with American Indians and Alaska Natives: Findings and
recommendations of the first symposium of the work group on American
Indian Research and Program Evaluation Methodology. American Indian
and Alaska Native Mental Health Research, 12, 1-21.
Carter-Pokras, O. and Baquet, C. (2002). What is a “health disparity”? Public
Health Report, 117, 426-434.
Centers for Disease Control and Prevention (2013). Web-based injury statistics
query and reporting system (WISQARS). National Center for Injury
Prevention and Control. Retrieved from: http://www.cdc.gov/injury/
wisqars/index.html.
Centers for Disease Control and Prevention (2015). American Indian
and Alaska Native populations. Retrieved from: http://www.cdc.gov/
minorityhealth/populations/REMP/aian.html
Chandler, M.J. and Lalonde, C. (1998). Cultural continuity as a hedge against
suicide in Canada’s First Nations. Transcultural Psychiatry, 191-219.

Cokley, K. (2007). Critical issues in the measurement of ethnic and racial

identity: A referendum on the state of the field. Journal of Counseling
Costello, E.J., Erkanli, A., Copeland, W. and Angold, A. (2010). Association
of family income supplements in adolescence with development of
psychiatric and substance use disorders in adulthood among an American
Indian population. Journal of the American Medical Association, 290,
1954-1960.
Costello, E.J., Farmer, E.M.Z., Angold, A., Burns, B.J. and Erkanli, A. (1997).
Psychiatric disorders among American Indian and white youth in
Appalachia: The Great Smoky Mountains Study. American Journal of
Public Health, 87, 827-832.
Cummins, J., Ireland, M., Resnick, M. and Blum, R. (1999). Correlates of
physical and emotional health among Native American adolescents.
Journal of Adolescent Health, 24, 38-44.
De Ravello, L., Abeita, J. and Brown, P. (2008). Breaking the cycle/Mending
the hoop: Adverse childhood experiences among incarcerated American
Indian/Alaska Native women in New Mexico. Health Care for Women
International, 29, 300-315.
Dillard, D., Jacobsen, C., Ramsey, S. and Manson, S. (2007). Conduct
disorder, war zone stress, and war-related posttraumatic stress disorder
symptoms in American Indian Vietnam veterans. Journal of Traumatic
Stress, 20, 53-62.
Dong, M., Anda, R.F., Felitti, V.J., Dube, S.R., Williamson, D.F., Thompson,
T.J., Loo, C.M. and Giles, W.H. (2004). The interrelatedness of multiple
forms of childhood abuse, neglect, and household dysfunction. Child
Abuse and Neglect, 28, 771-784.
Dube, S.R., Anda, R.F., Felitti, V.J., Croft, J.B., Edwards, V.J. and Giles,
G.W. (2001). Growing up with parental alcohol abuse: Exposure to
childhood abuse, neglect, and household dysfunction. Child Abuse and
Neglect, 25, 1627-1640.
Duran, B., Sanders, M., Skipper, B., Waitzkin, H., Malcoe, L.H., Paine, S. and
Yager, J. (2004). Prevalence and correlates of mental disorders among
Native American women in primary care. American Journal of Public
Health, 94, 71-77.
Duran, E. and Duran, B. (1995). Native American postcolonial psychology.
Albany, NY: SUNY.
Elias, B., Mignone, J., Hall, M., Hong, S.P., Hart, L. and Sareen, J. (2012).
Trauma and suicide behaviour histories among a Canadian indigenous

population: An empirical exploration of the potential role of Canada’s

residential school system. Social Science and Medicine, 74, 1560-1569.
Flora, J. (2012). “I don’t know why he did it. It happened by itself”: Causality
and suicide in northwest Greenaldn. In C. High, A.H. Kelly, and J. Mair
(Eds.), The anthropology of ignorance: An ethnographic approach (pp.
137-162.). New York, NY: Palgrave Macmillan.
Frank, M.L. and Lester, D. (2002). Self-destructive behaviors in American
Indian and Alaska Native high school youth. American Indian and Alaska
Native Mental Health Research, 10, 24-32.
Freedenthal, S. and Stiffman, A.R. (2004). Suicidal behavior in urban
American Indian adolescents: A comparison with reservation youth in a
Southwestern state. Suicide and Life-Threatening Behavior, 34, 160-171.
Garroutte, E.M., Goldberg, J., Beals, J., Herrell, R., Manson, S.M. and AI-
SUPERPFP Team. (2003). Spirituality and attempted suicide among
American Indians. Social Science and Medicine, 56, 1571-1579.
Garwick, A. and Auger, S. (2000). What do providers need to know about
American Indian culture? Recommendations from urban Indian family
caregivers. Families, Systems, and Health, 18, 177-189.
Gilder, D.A., Wall, T.L.,& Ehlers, C.L. (2004). Comorbidity of select anxiety
and affective disorders with alcohol dependence in Southwest California
Indians. Alcoholism: Clinical and Experimental Research, 28, 1805-1813.
Gone, J.P. (2004). Mental health services for Native Americans in the 21st
century United States. Professional Psychology: Research and Practice,
35, 10-18.
Gone, J.P. (2007). “We never was happy living like a Whiteman”: Mental
health disparities and the postcolonial predicament in American Indian
communities. American Journal of Community Psychology, 40, 290-300.
Gone, J.P. (2008). “So I can be like a Whiteman”: The cultural psychology of
space and place in American Indian mental health. Cultural Psychology,
14(3), 369–399.
Gone, J.P. and Trimble, J.E. (2012). American Indian and Alaska Native
mental health: Diverse perspectives on enduring disparities. Annual
Review of Clinical Psychology, 8, 131-160.
Goodluck, C.T. and Willeto, A.A.A. (2001). Native American kids 2001:
Indian children’s well-being indicators data book. Seattle, WA: Casey
Family Programs.
Harris, M.B., Page, P. and Begay, C. (1988). Attitudes toward aging in a
Southwestern Sample: Effects of ethnicity, age, and sex. Psychological
Reports, 62, 735-746.

Hartshorn, K.J.S., Whitbeck, L.B. and Hoyt, D.R. (2012). Exploring the
relationships of perceived discrimination, anger, and aggression among
North American Indigenous adolescents. Society and Mental Health, 2,
53-67.
Hawkins, E.H., Cummins, L.H. and Marlatt, G.A. (2004). Preventing
substance abuse in American Indian and Alaska Native youth: Promising
strategies for healthier communities: Psychological Bulletin, 130, 304-
323.
Heinrich, R.K., Corbine, J.L. and Thomas, K.R. (1990). Counseling Native
Americans. Journal of Counseling and Development, 69, 128-133.
Henry, K.L., McDonald, J.N., Oetting, E.R., Silk Walker, P., Walker, R.D. and
Bauvais, F. (2011). Age of onset of first alcohol intoxication and
subsequent alcohol use among urban American Indian adolescents.
Psychology of Addictive Behaviors, 25, 48-
Hertzman, C. (1999) The biological embedding of early experience and its
effects on health in adulthood. Annals of the New York Academy of
Sciences, 896, 95-95.
House, L., Stiffman, A.R. and Brown, E. (2006). Unraveling cultural threads:
A qualitative study of ethnic identity among urban southwestern American
Indian youth and parents, and elders. Journal of Child and Family Studies,
15, 393-407.
Indian Health Service (2004). Trends in Indian health 2002-2003. Rockville,
MD: U.S. Department of Health and Human Services. Retrieved from:
http://www.ihs.gov/nonmedicalprograms/ihs_stats/files/Trends_02-
03_Entire%20Book%20(508).pdf.
Indian Health Service (2011a). Indian health service year 2011 profile.
Rockville, MD: Indian Health Service. Retrieved from: http://www.
ihs.gov/PublicAffairs/IHSBrochure/Profile2011.asp.
Indian Health Service (2011b). Fiscal year 2012: Justification of
estimates for appropriations committees. Rockville, MD: Indian
Health Service. Retrieved from: http://www.ihs.gov/nonmedicalprograms/
budgetformulation/documents/FY%202012%20Budget%20Justification.p
df.
Indian Health Service (2015). Disparities. Retrieved 18 January 2016 from
https://www.ihs.gov/newsroom/factsheets/disparities/.
Joe, J. and Malach, R. (1992). Families with Native American roots. In E.
Lynch, and M. Hanson (Eds.), Developing cross-cultural competence: A
guide for working with young children and their families (pp. 89-116).
Baltimore, MD: Paul H. Brookes Publishing Co.

Johnson, A.F. (1995). Resiliency mechanisms in culturally diverse families.

The Family Journal: Counseling and Therapy for Couples and Families,
3, 316-324.
Johnson, T. and Tomren, H. (1999). Helplessness, hopelessness, and despair:
Identifying the precursors to Indian youth suicide. American Indian
Culture and Research Journal, 23, 287-301.
Jones, M.D. and Galliher, R.V. (2007). Ethnic identity and psychosocial
functioning in Navajo adolescents. Journal of Research on Adolescence,
17, 683-696.
Kaiser Family Foundation (2013). Health coverage and care for American
Indian and Alaska Natives. Menlo Park, CA: Henry J. Kaiser Family
Foundation. Retrieved from: http://kff.org/disparities-policy/issue-brief/
health-coverage-and-care-for-american-indians-and-alaska-natives/
Kawachi, I., Subramanian, S.V. and Almeida-Filho, N. (2002). A glossary for
Health inequalities. Journal of Epidemiology and Community Health, 56,
647-652.
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M.,
Eshleman, S., Wittchen, H.U. and Kendler, K.S. (1994). Lifetime and 12-
month prevalence of DSM-III psychiatric disorders in the United States:
Results from the National Comorbidity Survey. Archives of General
Psychiatry, 51, 8-19.
Kessler, R.C., Michelson, K.D. and Williams, D.R. (1999). The prevalence,
distribution, and mental health correlates of perceived discrimination in
the United States. Journal of Health and Social Behavior, 40, 144-168.
Kirmayer, J.J., Dandeneau, S., Marshall, E., Phillips, M.K. and Williamson,
K.J. (2011). Rethinking resiliency from indigenous perspectives.
Canadian Journal of Psychiatry, 56, 84-91.
Kirmayer, L.J. (2012). Cultural competence and evidence-based practice in
mental health: Epistemic communities and the politics of pluralism. Social
Science and Medicine, 75(2), 249-256.
Kirmayer, L.J., Fletcher, C. and Boothroyd, L.J. (1997). Inuit attitudes toward
deviant behavior: A vignette study. Journal of Nervous and Mental
Disease, 185, 78-86.
Kral, M.J. and Idlout, L. (2009). Community wellness and social action in the
Canadian Arctic: Collective agency as subjective well-being. In L. J.
Kirmayer and Valaskakis, G.G. (Eds.), Healing traditions: The mental
health of aboriginal peoples in Canada. Vancouver, Canada: UBC Press.
Kral, M.J., Idlout, L., Minore, J.B., Dyck, R.J. and Kirmayer, L.J. (2011).
Unikkaartuit: Meanings of well-being, unhappiness, health, and

community change among Inuit in Nunavut, Canada. American Journal of

Community Psychology, 48, 426-438.
Krieger, N. (2001). A glossary for social epidemiology. Journal of
Epidemiology and Community Health, 55, 693-700.
Kuh, D.L. and Shlomo, Y.B. (1997). A life course approach to chronic disease
epidemiology: Tracing the origins of ill health from early to adult life.
Oxford, England: Oxford University Press.
Kunitz, S.J., Veazie, M. and Henderson, J.A. (2014). Historical trends and
regional differences in all-cause and amenable mortality among American
Indians and Alaska Natives since 1950. American Journal of Public
Health, 104, S268-S277.
LaFromboise, T.D. and Bigfoot, D.S. (1988). Cultural and cognitive
considerations in the prevention of American Indian adolescent suicide.
Journal of Adolescence, 11, 139-153.
LaFromboise, T.D. and Dizon, M.R. (2003). American Indian children and
adolescents. In J. Taylor Gibbs, and L.N., Huang (Eds.), Children of
color: Psychological interventions with culturally diverse youth (2nd ed.,
pp. 45-90). San Francisco, CA: Jossey Bass.
LaFromboise, T.D., Coleman, H. and Gerton, J. (1993). Psychological impact
of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395-
412.
LaFromboise, T.D., Trimble, J.E. and Mohatt, G.V. (1993). Counseling
intervention and American Indian tradition: An integrative approach. In
D.R. Atkinson, G. Morten, and D.W. Sue (Eds.), Counseling American
minorities (pp. 145-170). Dubuque, IA: William C. Brown.
Lakes K., Lopez, S.R., Garro, L.C. (2006). Cultural competence and
psychotherapy: applying anthropologically informed conceptions of
culture. Psychotherapy: Theory, Research, Practice, and Training, 43,
380–396.
Lanier, C. (2010). Structure, culture, and lethality: An integrated model
approach to American Indian suicide and homicide. Homicide Studies, 14,
72-89.
Libby, A.M., Orton, H.D., Novins, D.K., Beals, J., Manson, S.M. and AI-
SUPERPFP Team. (2005). Childhood physical and sexual abuse and
subsequent depressive and anxiety disorders for two American Indian
tribes. Psychological Medicine, 35, 329-340.
Luo, F., Florence, C.S., Quispe-Agnoli, M., Ouyang, L. and Crosby, A.E.
(2011). Impact of business cycles on U.S. suicide rates, 1928-2007.
American Journal of Public Health, 101, 1139-1146.

Lynch, J.W., Davey Smith, G., Kaplan, G.A. and House, J.S. (2000). Income
inequality and mortality: Importance to health of individual outcome,
psychosocial environment, or material conditions. BMJ, 320, 1200-1204.
Macartney, S., Bishaw, A. and Fontenot, K. (2013). Poverty rates for selected
detailed race and Hispanic groups by state and place: 2007-2011.
American Community Survey Reports: U.S. Census Bureau. Retrieved
from: https://www.census.gov/prod/2013pubs/acsbr11-17.pdf.
Mackin, J., Perkins, T. and Furrer, C. (2012). The power of protection: A
population-based comparison of Native and non-Native youth suicide
attempters. American Indian and Alaska Native Mental Health Research,
19, 20-54.
Mail, P.D., Heurtin-Roberts, S., Martin, S.E. and Howard, J. (2002). Alcohol
use among American Indians and Alaska Natives: Multiple perspectives
on a complex problem. Bethesda, MD: National Institute on Alcohol
Abuse and Alcoholism.
Manson, S.M. and Trimble, J.E. (1982). American Indian and Alaska Native
communities: Past efforts, future inquiries. In L.R. Snowden (Ed.),
Reaching the underserved: Mental health needs of neglected populations
(pp. 143-163). Beverly Hills, CA: SAGE.
Manson, S.M., Beals, J., Klein, S.A., Croy, C.D. and The AI-SUPERPFP
Team (2005). The social epidemiology of trauma among two American
Indian reservation populations. American Journal of Public Health, 95,
851-859.
May P.A., (1987). American Indian and Alaska Native Mental Health
Research: Suicide and self-destruction among American Indian youths.
The Journal of the National Center, 1, 51-69.
May, P.A., Serna, P., Hurt, L. and DeBruyn, L.M. (2005). Outcome evaluation
of a public health approach to suicide prevention in an American Indian
tribal nation. American Journal of Public Health, 95, 1238-1244.
McEwen, B.S. and Seeman, T. (1999). Protective and damaging effects of
mediators of stress: Elaborating and testing the concepts of allostasis and
allostatic load. Annals of the New York Academy of Sciences, 896, 30-47.
Moore, M. (2006). Conference explores racism in cities near reservations.
Missoulian. Retrieved from: http://missoulian.com/news/state-and-
regional/conference-explores-racism-in-cities-near-
reservations/article_95c8c9df-754a-5812-b4c8-a8aaff2f67b1.html.
National Institutes of Health (2010). Strategic plan to reduce and ultimately
eliminate health disparities: Fiscal years 2009-2013. Washington, D.C.:

U.S. Department of Health and Human Services. Retrieved from:

http://www.nimhd.nih.gov/about/strategicPlan.html.
National Institute of Mental Health (2016). Minority health and mental health
disparities program. Retrieved from: http://www.nimh.nih.gov/ about/
organization/gmh/minority-health-and-mental-health-disparities-program.
shtml
Nelson, S., Greenough, R. and Sage, N. (2009). Achievement gap patterns of
grade 8 American Indian and Alaska Native students in reading and math.
Washington, DC: U.S. Department of Education, Institute of Education
Sciences. Retrieved from: www.ies.ed.gov/ncee/edlabs.
Novins, D.K., Beals, J., Roberts, R.E. and Manson, S.M. (1999). Factors
Associated with Suicide Ideation among American Indian Adolescents:
Does Culture Matter? Suicide and Life-Threatening Behavior, 29, 4, 332-
346.
Office of Minority Health (2010). National partnership for action to end
health disparities: Chapter 1: Introduction. Retrieved from: http://www.
minorityhealth.hhs.gov/npa/templates/browse.aspx?&lvl=2&lvlid=34.
Office of Minority Health (2011). Action plan to reduce racial and ethnic
health disparities: A nation free of disparities in health and health care.
Retrieved from: http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_
Plan_complete.pdf.
Petoskey, E.L., Van Stelle, K.R. and DeJong, J.A. (1998). Prevention through
empowerment in a Native American community. Drugs and Society, 12,
147-162.
Pothoff, S.J., Bearinger, L.H., Skay, C.L., Cassuto, N., Blum, R.W. and
Resnick, M.D. (1998). Dimensions of risk behaviors among American
Indian youth. Archives of Pediatric and Adolescent Medicine, 152, 157-
163.
Rees, C., Freng, A., Winfree, L.T. (2014). The Native American adolescent:
Social network structure and perceptions of alcohol-induced social
problems. Journal of Youth and Adolescence, 43, 405-425.
Reeves, A., Stuckler, D., McKee, M., Gunnell, D., Chang, S.S. and Basu, S.
(2012). Increase in state suicide rates in the U.S.A. during economic
recession. The Lancet, 380, 1813-1814.
Rennison, C. (2001). Violent victimization and race, 1993-1998. U.S.
Washington, DC: Department of Justice, Office of Justice Programs.
Retrieved from: www.bjs.gov/content/pub/pdf/vvr98.pdf.

Rieckmann, T.R., Wadsworth, M.E. and Deyhle, D. (2004). Cultural identity,

explanatory style, and depression in Navajo adolescents. Cultural
Diversity and Ethnic Minority Psychology, 10, 365-382.
Robin, R.W., Chester, B., Rasmussen, J.K., Jaranson, J.M. and Goldman, D.
(1997a). Prevalence and characteristics of trauma and posttraumatic stress
disorder in a Southwestern American Indian community. American
Journal of Psychiatry, 154, 1582-1588.
Robin, R.W., Chester, B., Rasmussen, J.K., Jaranson, J.M. and Goldman, D.
(1997b). Prevalence, characteristics, and impact of childhood sexual abuse
in a Southwestern American Indian tribe. Child Abuse and Neglect, 21,
769-787.
Robin, R.W., Gottesman, I.I., Albaugh, B. and Goldman, D. (2007).
Schizophrenia and psychotic symptoms in families of two American
Indian tribes. BMC Psychiatry, 7, 1-8.
Sandefur, G.D. and Liebler, C.A. (1997). The demography of American Indian
families. Population Research Policy Review, 16, 95-114.
Sarche, M. and Spicer, P. (2008). Poverty and health disparities for American
Indian and Alaska Native children: Current knowledge and future
prospects. Annals of the New York Academy of Sciences, 1136, 126-136.
Saremi, A., Hanson, R.L., Williams, D.E., Roumain, J., Robin, R.W., Long,
J.C., Goldman, D. and Knowler, W.C. (2001). Validity of the CAGE
questionnaire in an American Indian population. Journal of Studies on
Alcohol and Drugs, 62, 294-300.
Schoenfeld, L. S., Lyerly R.J., Miller S.I. (1971). We like us. Mental Hygiene,
55, 171–173.
Shaughnessy, K., Doshi, S.R. and Jones, S.E. (2004). Attempted suicide and
associated health risks among Native American high school students.
Journal of School Health, 74, 177-182.
Smith, L. T. (1999). Decolonizing methodologies: Research and Indigenous
Peoples. Longon, England: Zed Books.
Stiffman, A. R., Alexander-Eitzman, B., Silmere, H., Osborne, V. and Brown,
E. (2007). From early to late adolescence: American Indian youth’s
behavioral trajectories and their major influences. Journal of the American
Academy of Child and Adolescent Psychiatry, 46, 849-858.
Stubben, J. (1997). Culturally competent substance abuse prevention research
among rural Native American communities. Rural substance abuse: State
of Knowledge and Issues. Washington, DC: National Institute on Drug
Abuse Research Monograph Series No. 168, 459-483.

Substance Abuse and Mental Health Services Administration (2014).

Behavioral health trends in the United States: Results from the 2014
National Survey on Drug Use and Health. Retrieved from: https://
nsduhweb.rti.org/respweb/project_description.html##.
Substance Abuse and Mental Health Services Administration (2016).
American Indian and Alaska Native: Tribal affairs. Retrieved from
http://www.samhsa.gov/behavioral-health-equity/ai-an.
Sue S. (1977). Community mental health services to minority groups: Some
optimism, some pessimism. American Psychologist, 32, 616–624.
Sue S., Allen, D.B. and Conaway, L. (1978).The responsiveness and equality
of mental health care to Chicanos and Native Americans. American
Journal of Community Psychology, 6, 137-146.
Sue S., Zane N., Hall G.C.N. and Berger L.K. (2009). The case for cultural
competency in psychotherapeutic interventions. Annual Review of
Psychology, 60, 525–548.
Sue, D.W. (2001). Multidimensional facets of cultural competence.
Counseling Psychologist, 29, 790–821.
Sullivan, E.M., Annest, J.L., Luo, F., Simon, T.R. and Dahlberg, L.L. (2013).
Suicide among adults aged 35-64 years – United States, 1999-2010.
Morbidity and Mortality Weekly Report, 62(17), 321-325. Retrieved
from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm.
Szlemko, W.J., Wood, J.W. and Thurman, P.J. (2006). Native Americans and
alcohol: Past, present, and future. The Journal of General Psychology,
133(4), 435-451.
Taylor, J. and Turner, R.J. (2002). Perceived discrimination, social stress, and
depression in the transition to adulthood: Racial contrasts. Social
Psychology Quarterly, 65, 213-225.
Thira, D. (2014). Aboriginal youth suicide prevention: A post-colonial
community-based approach. International Journal of Children, Youth, and
Family Studies, 5, 158-179.
Thurman, P.J. and Green, V.A. (1997). American Indian inhalant use.
American Indian and Alaska Native Mental Health Research, 8, 24-40.
Tjaden, P. and Thoennes, N. (2005). Prevalence, incidence, and consequences
of violence against women: Findings from the National Violence Against
Women Survey. Washington, DC: National Institute of Justice. Retrieved
from: http://www.ojpusdoj.gov.
U.S. Census Bureau (2015). American Indian and Alaska Native heritage
month: November 2015. Retrieved from: https://www.census.gov/
newsroom/facts-for-features/2015/cb15-ff22.html

U.S. Commission on Civil Rights (2003). A quiet crisis: Federal funding

and unmet needs in Indian country. Washington, DC: U.S. Commission
for Civil Rights. Retrieved from: http://www.usccr.gov/pubs/na0703/
na0204.pdf.
U.S. Commission on Civil Rights (2004). Native American health
care disparities briefing: Executive summary. Washington, DC. Retrieved
from: https://www.law.umaryland.edu/marshall/usccr/documents/
nativeamerianhealthcaredis.pdf.
U.S. Department of Health and Human Services (2007). Health, United States,
2007: With chartbook on trends in the health of Americans. Hyattsville,
MD: National Center for Health Statistics. Retrieved from: www.cdc.gov/
nchs/data/hus/hus07.pdf.
U.S. Department of Health and Human Services (2014). Child maltreatment
in 2014. Washington, DC: Administration for Children and
Families. Retrieved from: http://www.acf.hhs.gov/programs/cb/research-
data-technology/statistics-research/child-maltreatment.
Van Winkle, N.W. and May, P.A. (1986). Native American suicide in New
Mexico, 1957-1979: A comparative study. Human Organization, 45(4),
296-308.
Waldram, J.B. (2004). Revenge of the Windigo: The construction of the mind
and mental health of North American Aboriginal Peoples. Toronto:
University of Toronto Press.
Waller, M.A., Okamoto, S.K., Miles, B.W. and Hurdle, D.E. (2003).
Resiliency factors related to substance use/resistance: Perceptions of
Native adolescents of the Southwest. Journal of Sociology and Social
Welfare, 30, 79-94.
Wallerstein, N.B. and Duran, B. (2006). Using community-based participatory
research to address health disparities. Health Promotion and Practice, 7,
312-323.
Walls, M., Chapple, C. and Johnson, K. (2007). Strain, emotion, and suicide
among American Indian youth. Deviant Behavior, 28, 219-246.
Wendt, D.C. and Gone J.P. (2011). Rethinking cultural competence: Insights
from indigenous community treatment settings. Transcultural Psychiatry,
49. 206-222.
Wexler, L., Chandler, M., Gone, J.P., Cwik, M., LaFromboise, T., Brockie, T.,
O’Keefe, V., Walkup, J. and Allen, J. (2015). Advancing suicide
prevention research with rural American Indian and Alaska Native
populations. American Journal of Public Health, 105, 891-899.

Whitbeck, L. B., Chen, X., Hoyt, D.R. and Adams, G.W. (2004).
Discrimination, historical loss and enculturation: Culturally specific risk
and resiliency factors for alcohol abuse among American Indians. Journal
of Studies on Alcohol, 65, 409-418.
Whitbeck, L. B., Hoyt, D.R., McMorris, B.J., Chen, X. and Stubben, J.D.
(2001). Perceived discrimination and early substance abuse among
American Indian children. Journal of Health and Social Behavior, 42,
405-424.
Whitbeck, L.B., McMorries, B.J., Hoyt, D.R., Stubben, J.D. and LaFromboise,
T.D. (2002). Perceived discrimination, traditional practices, and
depressive symptoms among American Indians in the Upper Midwest.
Journal of Health and Social Behavior, 43, 400-418.
Whitbeck, L.B., Yu, M., Johnson, K.D., Hoyt, D.R. and Walls, M.L. (2008).
Diagnostic prevalence rates from early to mid-adolescence among
indigenous adolescents: First results from a longitudinal study. Journal of
the American Academy of Child and Adolescent Psychiatry, 47, 890-900.
Whitehead, M. (1991). The concepts and principles of equity and health.
Copenhagen: WHO. Retrieved from: salud.ciee.flacso.org.ar/flacso/
optativas/equity_and_health.pdf.
Williams, D.R., Neighbors, H.W. and Jackson, J.S. (2003). Racial/ethnic
discrimination and health: Findings from community studies. American
Journal of Public Health, 98, S29-S37.
Yu, M. and Stiffman, A. R. (2010). Positive family relationships and religious
affiliation as mediators between negative environment and illicit drug
symptoms in American Indian adolescents. Addictive Behaviors, 35, 694-
699.
Yu, M., Stiffman, A. R. and Freedenthal, S. (2005). Factors affecting
American Indian adolescent tobacco use. Addictive Behaviors, 30, 889-
904.
BIOGRAPHICAL SKETCH
Name: Elizabeth Terrazas-Carrillo
Affiliation: Texas A&M International University
Education: Doctor of Philosophy from the University of Oklahoma
Address: 5201 University Blvd., Laredo, TX 78041

Elizabeth Terrazas-Carrillo received her doctorate degree in Counseling

psychology from the University of Oklahoma in 2014. Dr. Terrazas earned her
Bachelor’s and Master’s degree in Counseling Psychology from Midwestern
State University. She also served as a pre-doctoral intern at the APA-approved
internship program at the Texas State University Counseling Center, where
she provided counseling services to a diverse client population. She is
currently an Assistant Professor of Counseling Psychology at Texas A&M
International University and is on her way to complete requirements for
becoming a licensed psychologist in Texas. Her research interests include
exploring the intersection of identities within vulnerable populations,
including international students, Mexican and Mexican American women, and
Spanish-speaking immigrants in the United States on a variety of issues
affecting mental health, psychological adjustment, and well-being. She has a
special interest in mentoring and supervising graduate students, as well as
fostering cultural competence among her counseling trainees.
Professional Appointments: Assistant Professor
Honors:
2015 American Psychological Association Psychology Summer
Institute Fellow
2012-2014 American Psychological Association Minority Fellow
2009-2013 University of Oklahoma Foundation Fellow
Terrazas-Carrillo, E., McWhirter, P.T. and Martel, K.M.* (in press).

Depression among Mexican women: The impact of nonviolent coercive
control, intimate partner violence and employment status. Journal of
Family Violence. doi: 10.1007/s108960169827-x.
Terrazas-Carrillo, E., Hong, J.Y., McWhirter, P.T., Robbins, R. and Pace,
T.M. (in press). Place-making and its impact on international graduate
student adjustment. Journal of College Student Retention: Theory,
Research, and Practice. doi: 10.1177/1521025115611403.
Terrazas-Carrillo, E. and McWhirter, P.T. (2015). Employment status and
intimate partner violence among Mexican women. Journal of Interpersonal
Violence, 30(7), 1128-1152. doi: 10.1177/0886260514539848.

Terrazas-Carrillo, E., Hong, J. Y. and Pace, T. M. (2014). Adjusting to new

places: International student adjustment and place attachment. Journal of
College Student Development, 55(7), 693-706. doi: 10.1353/
csd.2014.0070.
Terrazas-Carrillo, E. and McWhirter, P. T. (2012). Intimate partner violence
and substance abuse: Contextualizing sociocultural complexities. In
Cunningham, H. R., and Berry, W. F. (Eds.), Handbook on the
Psychology of Violence. Hauppauge, NY: Nova Science Publishers.
BIOGRAPHICAL SKETCH
Name: Paula T. McWhirter
Affiliation: The University of Oklahoma
Education: Post doctorate, The University of California, Los Angeles;
Pre doctoral internship: The University of Notre Dame; Ph.D. Counseling
Psychology, Arizona State University
Address: The University of Oklahoma Jeannine Rainbolt College of
Eduation; 820 Van Vleet Oval, Norman, Oklahoma.
Research and Professional Experience: Paula T. McWhirter, Ph.D. is

Professor in the Department of Educational Psychology at The University of
Oklahoma. As a Fulbright scholar to Chile, she completed her dissertation on
violence reduction interventions with high-risk youth and families while
training at a school-based family and community mental health center. Prior to
accepting her current position at the University of Oklahoma, McWhirter
specialized in work with domestic violence survivors and their families. She
served as Clinical Director for a comprehensive provider of behavioral health
services for over 1000 Medicaid eligible children and their families, directing
all aspects involving clinical policies, objectives, and initiatives, and providing
counseling consultation and supervision. Currently, she teaches and studies
positive psychology approaches, interpersonal violence interventions, and
therapeutic factors within group and family/child counseling.
Professional Appointments: Professor, The University of Oklahoma

Terrazas-Carrillo, E.C. and McWhirter, P.T. (2016). Employment status and

Violence, 30(7), 1128-1152. DOI: 10.1177/0886260514539848.
McWhirter, P.T., Brandes, J.A., Williams-Diehm, K., Hackett, S. (2016).
Interpersonal and relational orientation among preservice educators:
Differential effects on classroom inclusion of students with
exceptionalities. Teacher Development, 20 (1). doi: 10.1080/
13664530.2015.1111930.
2015
Namjou-Khales, R. and McWhirter, P.T. (2015). Prevention of intimate

partner and family violence. In C. Juntunen and Atkinson (Eds.),
Counseling across the lifespan: Prevention and Treatment (2nd ed.).
California: Sage.
Terrazas-Carrillo, E.C., Hong, J.Y., McWhirter, P.T., Robbins, R., Pace, T.M.
(2015) Place-making and its impact on international graduate student
persistence. Journal of College Student Retention: Research Theory and
Practice. DOI:10.1177/1521025115611403.
Terrazas-Carrillo, E.C. and McWhirter, P.T. (2015). Employment status and
Violence, 30(7), 1128-1152. DOI: 0886260514539848.
Hackett, S., McWhirter, P.T. and Lesher, S. (2015). Therapeutic efficacy of
domestic violence victim interventions. Trauma, Violence, and Abuse.
doi: 10.1177/1524838014566720.
2014
Muetzelfeld, H.K. and McWhirter, P.T. (2014). Surviving to thriving: Positive

psychology perspectives on Trauma, Violence and Abuse. In E. Bellamy
(Ed.), Partner Violence: Risk factors, Therapeutic interventions and
psychological impact. (pp. 39-58). New York: Nova Publishers.
McWhirter, P.T., Nelson, J. and Waldo, M. (2014). Positive psychology and
curative community groups: Subjective wellbeing and group therapeutic
factors. Journal of Specialists in Group Work, 39(4), 366-380.
doi:10.1080/01933922.2014.955384.

Yager-Elorriaga, D., Berenson, K. and McWhirter, P.T. (2014). Hope, ethnic

pride, and academic achievement: Positive psychology and Latino youth.
Comer, K,, Latorre, C. and McWhirter, P. T. (2014). Utilizing the Strong
Interest Inventory to understand interpersonal dynamics in the workplace.
In K. Fineran, B. Houltberg, A. Nitza, J. McCoy, and S. Roberts (Eds.),
Group work experts share their favorite activities: A guide to choosing,
planning, conducting, and processing volume 2 (pp. 245-349). Alexandria,
VA: Association for Specialists in Group Work.
Huston, L. and McWhirter, P.T. (2014). Managing multiple role demands
among single/divorced parents. In K. Fineran, B. Houltberg, A. Nitza, J.
McCoy, and S. Roberts (Eds.), Group work experts share their favorite
activities: A guide to choosing, planning, conducting, and processing
volume 2 (pp.334-338). Alexandria, VA: Association for Specialists in
Group Work.
Latorre, C., Comer, K. and McWhirter, P.T. (2014). Facilitating interpersonal
awareness in the workplace. In K. Fineran, B. Houltberg, A. Nitza, J.
McCoy, and S. Roberts (Eds.), Group work experts share their favorite
activities: A guide to choosing, planning, conducting, and processing
volume 2 (pp.245-250). Alexandria, VA: Association for Specialists in
Group Work.

INDEX
adulthood, 157, 159, 165

# adults, 34, 36, 37, 38, 39, 40, 41, 42, 43, 44,
49, 54, 78, 79, 90, 91, 101, 107, 111,
20th century, 3, 71, 75, 84
116, 119, 121, 122, 124, 125, 138, 139,
21st century, 14, 72, 78, 84, 87, 158
156, 165
advancements, 16, 28, 80
A adverse effects, 119
adverse event, 109, 120
abuse, 77, 115, 136, 137, 138, 141, 142, affective disorder, 158
145, 146, 151, 154, 156, 157, 159, 161, Africa, 56
164, 167, 169 African Americans, 110
academic difficulties, 130 age, 13, 15, 17, 24, 35, 42, 73, 83, 85, 87,
access, 14, 44, 82, 99, 106, 107, 111, 113, 95, 106, 107, 109, 110, 112, 116, 125,
114, 118, 119, 122, 135, 136, 148, 149, 139, 141, 158
151, 153, 154 agencies, 54, 152
accessibility, 124, 148 aggression, 144, 159
accountability, 120 aggressive behavior, 144
accounting, 136 aging process, 119
accreditation, 129 agriculture, 17, 50
acculturation, 2, 13, 144 AIDS, 145
acid, 88, 89 Alaska, 72, 122, 123, 124, 125, 133, 137,
ACL, 106, 107 139, 142, 154, 155, 156, 157, 158, 159,
adaptation, 32, 33 160, 161, 162, 163, 164, 165, 166
adiposity, 94, 102 Alaska Natives, 72, 122, 133, 156, 160, 161,
adjustment, 27, 168, 169 162
Administration for Children and Families, alcohol abuse, 137, 138, 154, 157, 167
166 alcohol consumption, 141
administrators, 63 alcohol dependence, 138, 139, 158
adolescents, 138, 139, 140, 144, 156, 157, alcohol use, 141, 159
158, 159, 160, 161, 164, 166, 167

174 Index
alcoholism, 138, 155 barriers, 28, 111, 113, 114, 135, 140, 148,
alienation, 141, 146 149, 153
amalgam, 2 base, 99, 111, 160, 162, 165, 166, 169
American Indian elders, 105, 106, 107, 108, behaviors, 106, 113, 115, 135, 136, 139,
109, 110, 111, 113, 114, 116, 118, 119, 141, 144, 145, 158, 163
121, 123 belief systems, 12
American Indians and Alaska Natives, 122, beneficiaries, 109, 124
133, 156, 161, 162 benefits, 15, 16, 77, 113, 115, 152, 154
American Psychological Association, 168 beverages, 16, 101, 102
ancestors, 8, 10, 20, 145 bias, 148
anchoring, 55 binge drinking, 138, 141
anemia, 99 biodiversity, 31, 34, 41, 49, 53
anger, 144, 145, 159 birds, 12, 20, 48, 49, 75
anthropologists, 52 birth weight, 78
anthropology, 24, 88, 98, 158 BJS, 134
anti-inflammatory drugs, 125 bleeding, 8
antipsychotic, 128 blogs, 15
anxiety, 133, 134, 137, 138, 145, 158, 161 blood, 92
anxiety disorder, 138, 161 body fat, 93
APA, 168 body image, 79
appointments, 126 body size, 74, 79, 82, 94, 102
appropriations, 159 body weight, 85, 99
Argentina, 2, 31, 34, 37, 39, 40, 55, 56, 57, bonds, 86
58, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69 Brazil, 1, 2, 3, 4, 5, 6, 14, 15, 19, 21, 22, 24,
artery, 110, 122 25, 26, 29, 30, 34, 64
arthritis, 107, 109 Brazilian Indigenous Peoples, 1, 3, 6, 7, 12,
arthropods, 5 13, 14, 15, 21, 23
articulation, 20, 21, 38 breakdown, 73
artistic expressions, 1, 3, 7, 12, 13 breast milk, 84
assessment, 118, 129, 138 breastfeeding, 71, 84, 86, 103
assimilation, 12, 74, 134, 144 bullying, 28
asthma, 106, 109, 110, 121 Bureau of Justice Statistics, 156
atrocities, 134 burn, 12, 35
attachment, 169 business cycle, 161
attitudes, 101, 116, 146, 150, 160
authorities, 5, 21, 41
autonomy, 13, 15, 16, 75
C
awareness, 94, 125, 134, 151, 154, 171
calcium, 103
Cameroon, 55
B Canada, 71, 72, 73, 77, 79, 88, 89, 91, 92,
93, 94, 95, 97, 98, 99, 100, 101, 102,
Bangladesh, 97, 102 138, 144, 145, 156, 158, 160, 161
candidates, 10

Index 175
cardiovascular disease, 117 clients, 73, 100, 101

caregivers, 115, 123, 124, 158 climate, 17
case studies, 28 climate change, 17
case study, 27, 55, 58, 59 clothing, 12
CDC, 119, 122, 126, 134, 139 cognition, 36
CD-ROM, 69 cognitive skills, 42
cell phones, 14 collaboration, 152
Census, 22, 106, 107, 125, 134, 137, 142, Colombia, 68
143, 162, 165 colonization, 2, 17, 18, 34, 71, 73, 74, 75,
ceramic, 12, 13 84, 144
challenges, 1, 3, 14, 15, 21, 23, 26, 27, 52, color, 2, 161
54, 55, 72, 74, 80, 84, 95, 106, 107, 114, commercial, 17
115, 137, 148 communication, 14, 15, 24, 125
changing environment, 32, 33, 38 communication technologies, 15
cheese, 80 communities, 1, 4, 5, 10, 15, 24, 32, 33, 34,
chicken, 80 35, 36, 38, 39, 40, 43, 52, 53, 54, 57, 67,
child abuse, 142, 145 73, 74, 75, 76, 77, 78, 80, 81, 85, 87, 89,
child development, 33, 38 95, 97, 99, 103, 134, 135, 137, 140, 141,
childcare, 86 142, 144, 145, 146, 147, 148, 150, 151,
childhood, 36, 37, 40, 42, 59, 68, 99, 102, 152, 153, 154, 158, 159, 160, 162, 164
136, 140, 141, 145, 151, 154, 155, 156, comparative analysis, 81
157, 164 complement, 6, 37
childhood sexual abuse, 164 complexity, 42, 134, 151
childrearing, 35, 38 complications, 73, 83, 118
children, 9, 11, 24, 32, 33, 36, 37, 38, 39, composition, 88
40, 41, 42, 43, 44, 45, 48, 49, 50, 52, 53, computer, 15
54, 56, 57, 59, 67, 68, 71, 77, 78, 80, 81, conception, 12
84, 89, 94, 96, 100, 101, 102, 103, 136, conceptualization, 56, 140
141, 142, 144, 158, 159, 161, 164, 167, concordance, 120, 125
169 conduct disorder, 138
Chile, 2, 169 conductor, 11
Christianity, 18 conference, 162
chronic diseases, 99, 116 conflict, 23, 53
chronic illness, 119 confrontation, 2, 20
circulation, 14 congress, 19, 20, 56, 59, 68, 69, 70, 138,
cities, 6, 16, 20, 21, 162 145, 148, 149
citizens, 3, 21 connectivity, 14
civilization, 4 consent, 80
clarity, 120 Constitution, 19
classes, 86 constitutional amendment, 20
classification, 111 construction, 5, 87, 166
classroom, 23, 43, 170 consumers, 119
cleaning, 43 consumption, 72, 74, 78, 79, 82, 84, 87, 141

176 Index
contamination, 77 degradation, 85
content analysis, 81 DEL, 64
controversies, 59 delegates, 20
conversations, 39 delinquent behavior, 141
cooking, 40, 43, 82, 85, 86 demographic data, 106
cooperation, 83 demography, 123, 164
coronary artery disease, 110, 122 demonstrations, 20
correlation, 82 Department of Education, 163, 169
corticosteroids, 111 Department of Health and Human Services,
cost, 107, 113, 122 107, 108, 114, 126, 135, 137, 159, 163,
cotton, 17 166
counsel, 146 Department of Justice, 163
counseling, 73, 87, 168, 169 depression, 133, 134, 137, 142, 144, 145,
covering, 149 151, 155, 156, 164, 165
creativity, 22, 24, 26, 27, 28, 30, 86 depressive symptoms, 167
criticism, 36 deprivation, 142, 151
crops, 17, 50 depth, 153
cross-sectional study, 100 despair, 160
cultivation, 12 destruction, 2, 162
cultural beliefs, 59, 151 diabetes, 16, 72, 73, 74, 78, 79, 89, 90, 91,
cultural differences, 137, 139, 153 92, 93, 94, 101, 106, 107, 109, 110, 117,
cultural practices, 35 121, 123, 124, 125
cultural tradition, 72, 146 diet, 75, 77, 78, 79, 81, 83, 84, 89, 91
cultural values, 115, 146, 147 dietary fat, 85
culturally competent care, 73, 74 dignity, 92
culture, 1, 2, 3, 12, 16, 18, 21, 22, 30, 37, directives, 152
39, 43, 50, 54, 56, 74, 77, 78, 81, 90, disability, 105, 107, 119, 121, 124
111, 115, 117, 135, 145, 146, 150, 153, discontinuity, 31, 32, 34, 39
158, 161, 163 discrimination, 136, 140, 143, 144, 146,
cure, 8, 10, 22 148, 151, 153, 154, 159, 160, 165, 167
curriculum, 43, 56, 127 diseases, 5, 8, 10, 11, 16, 17, 18, 79, 99,
cycles, 161 116, 117
disorder, 27, 133, 134, 137, 138, 155, 157,
164
D displacement, 44, 144
dissatisfaction, 94, 102
dances, 2, 10, 11, 13
distress, 91, 92, 137
data collection, 38, 105
distribution, 93, 106, 107, 126, 160
database, 109
diversity, 1, 2, 3, 7, 23, 38, 40, 49, 53, 54,
de fevereiro, 5
56, 59, 151
deaths, 11, 134
DOI, 98, 170
deficiencies, 138
domestic tasks, 35
deficit, 138
domestic violence, 141, 142, 169, 170
deforestation, 45, 48, 50

Index 177
dominance, 2 enskillment, 32, 36, 40

dosing, 119 environment, 17, 32, 33, 35, 36, 37, 38, 40,
drawing, 50 41, 49, 52, 53, 54, 72, 80, 86, 89, 97,
dream, 10 102, 112, 136, 162, 167
drought, 8 environmental change, 52
drug dependence, 137, 139 environmental conditions, 36, 37, 38
drug therapy, 114, 120 environments, 32, 33, 36, 42, 54, 95, 145
drugs, 125, 141 epidemic, 72
epidemiology, 99, 130, 155, 161, 162
epistemology, 152
E equality, 165
equity, 125, 165, 167
ecology, 33
ethnic groups, 1, 2, 20, 138
economic development, 142
ethnicity, 6, 8, 102, 103, 111, 124, 136, 156,
economic disadvantage, 135
158
economic downturn, 142
ethnobiologists, 52
economic systems, 136
ethnographic study, 32, 53
edema, 9
etiology, 116
education, 21, 22, 27, 28, 29, 33, 43, 44, 54,
euphoria, 3
57, 80, 101, 103, 112, 116, 129, 143
everyday life, 40, 53, 56, 150
educational assessment, 129
evidence, 4, 34, 38, 118, 121, 140, 147, 151,
educational attainment, 140
160
educators, 170
evil, 9, 10, 18
Eeyou women, 71, 74, 84, 87
evolution, 56
elderly leaders, 32
expectations, 31, 32, 33, 37, 39, 43, 44
elders, 32, 34, 39, 40, 43, 49, 52, 54, 71, 73,
expenditures, 150
74, 78, 80, 81, 82, 83, 84, 85, 86, 87, 88,
experimental design, 153
95, 105, 106, 107, 108, 109, 110, 111,
exploitation, 2, 13, 18, 20, 77
112, 113, 114, 121, 122, 123, 146, 159
exposure, 74, 79, 136, 142, 145
electricity, 50, 77
extinction, 21
emotion, 27, 67, 166
extraction, 5, 34
emotional experience, 57, 67
extreme poverty, 16
emotional health, 147, 157
emotional problems, 150
emphysema, 109 F
employment, 77, 82, 85, 149, 168
employment status, 168 faculty development, 128
empowerment, 163 families, 7, 68, 73, 75, 82, 97, 138, 144,
enculturation, 146, 167 146, 159, 160, 164, 169
endurance, 85 family income, 157
energy, 14, 19, 74, 75, 79 family members, 115, 141
engineering, 17 family relationships, 167
England, 25, 125, 161, 164 family violence, 170
enrollment, 149 farmers, 15, 19

178 Index
fast food, 80 genocide, 144

fasting, 82 geography, 103, 112, 119
fat, 78, 79, 84, 85, 86, 93 Georgia, 56, 59
fear, 77 gestational diabetes, 73, 78, 91
federal government, 77, 114, 144, 149 gifted, 27, 28
Federal Government, 79 giftedness, 22, 28, 30
feelings, 102 GIS, 124
financial, 18, 64, 107, 117 glucose, 117, 122
financial resources, 18 glucose tolerance, 122
financial support, 64 goose, 79, 80, 88
firearms, 42 governments, 19
First Nations, 72, 73, 74, 75, 79, 89, 90, 91, grades, 43
92, 93, 95, 99, 101, 103, 156 graduate program, 28
fiscal year, 108 graduate students, 168
fish, 9, 16, 42, 75, 77, 79, 82, 89 group activities, 143
fishing, 15, 17, 35, 72, 78 group identity, 12
fitness, 9 growth, 17, 34
flexibility, 53 growth rate, 34
flooding, 5, 14 guardian, 24
flour, 35, 75 guidance, 41, 43, 73, 130
food, 4, 9, 16, 35, 43, 44, 45, 58, 59, 69, 72, guidelines, 91, 101
74, 75, 77, 78, 79, 80, 82, 85, 86, 87, 88,
89, 94, 95, 96, 97, 99, 100, 101, 102,
115, 136
H
food intake, 82
habits, 1, 2, 14, 42, 90, 101
food security, 99, 102
hair, 9
force, 145
harmony, 13
forest resources, 46
harvesting, 8, 90
formal education, 33
healing, 10, 11, 72, 87, 122, 124, 135, 153,
formation, 2, 22
154
fossils, 4
Health and Human Services, 114, 135, 137,
foundations, 94
159, 163, 166
freedom, 13, 117
health care, 67, 73, 74, 77, 80, 87, 89, 105,
fruits, 2, 42, 48, 85
107, 108, 110, 111, 113, 114, 117, 118,
funding, 107, 114, 130, 148, 149, 151, 152,
119, 120, 125, 148, 149, 150, 151, 153,
154, 166
163, 165, 166
funds, 107, 150
health care professionals, 73, 77, 88
health care system, 113
G health condition, 117, 118, 135
health insurance, 135, 148, 149
garbage, 17 health practitioners, 150
gender role, 95, 102, 145 health problems, 71, 73, 82
genetic engineering, 17 health promotion, 72, 87, 95, 99

Index 179
health risks, 164 images, 14, 15, 54, 79

health services, 77, 114, 135, 149, 150, 155, immigrants, 22, 168
158, 165, 169 immunization, 111
health status, 106, 113, 116, 118, 119, 120, improvements, 111
123, 126 incarceration, 145
heart failure, 116, 125 incidence, 5, 16, 135, 140, 165
HHS, 107, 135, 142, 163 income, 77, 112, 115, 142, 157
high school, 143, 158, 164 India, 3, 69, 70, 95
high school diploma, 143 Indian reservation, 155, 162
higher education, 21, 27 Indians, 2, 3, 4, 5, 6, 7, 9, 10, 12, 15, 16, 17,
highways, 5, 43 18, 20, 24, 72, 89, 90, 92, 93, 105, 106,
history, 1, 3, 36, 39, 54, 56, 71, 74, 82, 85, 107, 108, 109, 110, 111, 113, 114, 115,
127, 133, 134, 138, 141, 142, 144, 145 116, 117, 118, 119, 120, 122, 123, 124,
home ownership, 136 133, 137, 138, 139, 150, 156, 158, 161,
homes, 80, 127, 128 162, 167
homicide, 161 indigenous, 1, 1, 2, 3, 4, 5, 6, 7, 9, 10, 12,
honesty, 120 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23,
hopelessness, 141, 160 24, 30, 31, 35, 36, 43, 44, 52, 53, 54, 55,
host, 142, 151, 153 58, 64, 65, 66, 67, 68, 72, 73, 77, 79, 87,
House, 136, 146, 159, 162 91, 94, 97, 99, 101, 102, 124, 134, 140,
household income, 142 144, 145, 147, 152, 154, 156, 157, 159,
housing, 77, 115 160, 164, 166, 167
human, 3, 4, 12, 13, 14, 17, 36, 39, 43, 56, indigenous knowledge, 73
58, 95, 98 indigenous peoples, 1, 2, 3, 4, 5, 6, 7, 12,
human activity, 13 13, 14, 15, 16, 18, 19, 20, 21, 23, 52, 54,
human cognition, 36 55, 72, 73, 99, 145, 147
human development, 36, 43, 58 individual development, 45, 129
human health, 95 individuality, 145
hunter-gatherers, 56 individuals, 3, 6, 7, 11, 12, 35, 54, 78, 85,
hunting, 5, 8, 15, 17, 35, 42, 56, 72, 74, 75, 102, 115, 116, 134, 135, 138, 139, 141,
77, 87 153
husband, 7 industries, 19
hygiene, 2 ineffectiveness, 120
hyperactivity, 138 inequality, 142, 162
hypertension, 16, 109, 121 infancy, 38
hypothesis, 4 infants, 83, 85, 86, 94, 103
influenza, 4, 111
influenza a, 4, 111
I influenza vaccine, 111
informed consent, 80
identification, 8, 153
infrastructure, 77
identity, 7, 12, 16, 50, 54, 72, 78, 87, 88,
injury, 155, 156
143, 144, 146, 157, 159, 160, 164
insecurity, 99, 101
ideology, 4

180 Index
institutions, 13, 33, 147, 148 landscapes, 59, 55

insulin, 91, 116, 122 languages, 1, 7, 74, 144
insulin resistance, 91, 116, 122 later life, 59
integration, 5, 17, 24, 35, 87, 135, 154 Latin America, 2, 52, 66, 68, 69, 97
integrity, 144 lead, 52, 82, 121, 143, 153
intensive care unit, 73 leadership, 128
intercourse, 10 learning, 32, 33, 35, 36, 37, 38, 39, 40, 41,
interdependence, 146 52, 53, 54, 56, 57, 58, 59, 128, 129, 136
interface, 56 learning environment, 53, 54
internal validity, 152 learning process, 33, 40, 52, 53
internship, 168, 169 legislation, 22
interrelatedness, 157 leisure, 34, 52, 53, 136
intervention, 16, 99, 134, 135, 152, 161 lens, 92, 102, 154
intimacy, 13 life course, 161
intoxication, 159 life cycle, 43
invasions, 18 life expectancy, 107, 118
inventions, 17 life experiences, 33, 53
Iowa, 126 lifetime, 134, 137, 138, 139, 142
Ireland, 146, 156, 157 light, 74, 85, 153
islands, 4 lipids, 110
isolation, 114, 141 literacy, 15, 149
issues, 20, 37, 39, 69, 93, 105, 106, 111, livestock, 34, 35
113, 115, 119, 120, 121, 134, 135, 140, living conditions, 33
148, 150, 151, 152, 157, 168 locus, 36
Italy, 101 logging, 77
longevity, 118
longitudinal study, 138, 167
J love, 81
Luo, 142, 161, 165
James Bay, 71, 74, 75, 76, 77, 81, 88, 89,
90, 91, 92, 93
Jordan, 89 M
macrosomia, 73
K major depressive disorder, 137
majority, 1, 6, 50, 78, 99, 137, 143
kindergarten, 143
malaria, 5
kinship, 45
maltreatment, 115, 166
knowledge acquisition, 55
mammals, 75, 85
management, 37, 38, 54, 105, 106, 108, 110,
L 113, 115, 116, 118, 120, 121, 124, 125,
128
labeling, 143 mapping, 102, 124
lactation, 84, 93 marriage, 8, 9

Index 181
materials, 12, 43, 54 Mexico, 2, 59, 64, 67, 106, 116, 137, 139,
mathematics, 56 140, 157, 166
matter, 125 microelectronics, 14, 16
Mbya Guarani, 31, 45, 60, 67, 68, 69 minorities, 113, 144, 161
Mbya Indigenous Communities, 31 minority groups, 106, 112, 115, 165
Mbya reko, 31, 34, 35, 41 misuse, 109
measles, 4 mobile device, 14
measurement, 26, 27, 139, 157 mobile phone, 14
meat, 79, 82, 86 models, 32, 33, 34, 39, 44, 53, 54
media, 15, 79, 123 modernity, 72, 87
median, 142 mollusks, 5
mediation, 14 Montana, 137
Medicaid, 113, 149, 154, 169 Moon, 17
medical, 77, 92, 111, 114, 116, 119, 135, morbidity, 73
148 mortality, 73, 134, 135, 154, 161, 162
medical care, 77, 114 mother tongue, 15
Medicare, 108, 109, 110, 113, 122 motivation, 29
medication, 105, 106, 107, 108, 109, 110, multidimensional, 152
111, 113, 116, 117, 118, 119, 120, 121, muscles, 9
123, 124, 125, 126, 127, 128 music, 15, 41
Medication Use, 105, 106, 107, 108, 109, muskrat, 85
110, 111, 112, 113, 117, 118, 119, 121, myths, 1, 3, 7, 12, 40, 41
123, 124, 126, 127, 128
medicine, 17, 62, 116, 118, 124, 150
mellitus, 73, 78, 90, 109
N
membership, 113
nanotechnology, 14
mental disorder, 137, 139, 151, 155, 157
National Institute of Mental Health, 135,
Mental Health, 62, 133, 134, 135, 136, 137,
163
138, 139, 143, 148, 149, 150, 151, 152,
National Institutes of Health, 162
153, 154, 155, 156, 158, 159, 160, 162,
National Survey, 165
163, 165, 166, 168, 169
Native Americans, 124, 155, 158, 159, 165
mental health difficulties, 133
Native communities, 162
mental health disparities, 134, 135, 136,
native peoples, 1
137, 148, 151, 153, 154, 155, 158, 163
native population, 2
mental illness, 136, 137, 141, 142, 145, 146,
native species, 48
151, 152, 153, 154
natural resources, 5, 13, 17, 19, 38, 77
mentor, 130
nausea, 10, 85
mentoring, 168
NCS, 137
mentorship, 99
negative attitudes, 150
Mercosul, 55
negative outcomes, 142
mercury, 77
neglect, 115, 141, 142, 145, 157
Metabolic, 93
New England, 125
methodology, 53, 96
NGOs, 43, 50

182 Index
non-renewable resources, 17 patient care, 87, 116

North America, 4, 92, 159, 166 peer group, 48
nurses, 77 peer interactions, 32
nursing, 90, 92, 109, 123, 127, 128 peer review, 130
nursing home, 109, 123, 127, 128 PEP, 125
nutrients, 74, 75, 78 perinatal, 96
nutrition, 73, 77, 85, 89, 91, 95, 99, 100, permission, 76
101, 103 perpetration, 155
nutritional status, 78 perpetrators, 144
personal communication, 5, 8, 9, 13, 15, 16,
21
O personal responsibility, 118
personhood, 85
obesity, 71, 72, 73, 74, 78, 79, 86, 87, 89,
Peru, 2, 25
90, 92, 93, 99, 101, 102, 116
pessimism, 165
Office of Justice Programs, 163
pharmacotherapy, 123
Oklahoma, 106, 110, 133, 137, 167, 168,
phobia, 139
169
phonemes, 7
openness, 18, 43, 50, 120
physical abuse, 142
opportunities, 32, 35, 41, 44, 54, 55, 95,
physical activity, 71, 80, 83, 84, 97
152, 154
physical characteristics, 4
oppression, 133
physical health, 118
optimism, 165
physicians, 125
organize, 20, 43
physiology, 136
otherness, 50
pilot study, 97
overlap, 148
placenta, 8
overweight, 86
plants, 13, 42, 50, 144
ownership, 136
playing, 45
pluralism, 160
P pneumonia, 111
poison, 11, 20
pain, 11, 124, 125, 145 policy, 18, 153, 160
pain care, 124 political power, 21
pain management, 125 politics, 22, 160
paints, 12 pollution, 49
Paraguay, 34 population, 1, 6, 14, 17, 61, 73, 89, 90, 91,
parallel, 77 99, 105, 106, 107, 108, 111, 113, 114,
Paranaense Rainforest, 31, 34 116, 117, 119, 121, 122, 125, 133, 134,
parents, 33, 43, 44, 50, 54, 68, 83, 86, 141, 137, 138, 139, 140, 141, 142, 143, 145,
146, 155, 159, 171 150, 157, 158, 162, 164, 168
participants, 75, 95, 99, 109, 110, 117 population density, 141
pasta, 35 population growth, 17
pathways, 32, 33, 45, 52, 53, 54, 116, 134, Portugal, 25
136, 142

Index 183
postnatal care, 71, 73, 74

posttraumatic stress, 133, 134, 155, 157,
Q
164
qualitative, 71, 81, 84, 90, 95, 96, 98, 128,
potato, 81
153, 159
poverty, 16, 134, 142, 143
qualitative research, 81, 84, 90
POWER, 88
quality improvement, 126
power generation, 5, 23
quality of life, 50, 53, 86, 109, 123
pregnancy, 71, 73, 74, 83, 84, 85, 91, 92,
Quebec, 71, 74, 77, 81, 88, 91, 94
93, 96, 97, 103
query, 156
prejudice, 21
questioning, 32, 33, 53
prenatal care, 91, 136
questionnaire, 164
preparation, 9, 17, 82, 85, 86
quotas, 21
president, 19, 25
prevalence rate, 138
prevention, 75, 124, 134, 135, 152, 153, R
154, 161, 162, 164, 165, 166
principles, 4, 102, 167 race, 111, 116, 120, 124, 125, 141, 162, 163
procurement, 58 racial oppression, 133
professional development, 154 racing, 161
professionals, 2, 7, 43, 63, 73, 77, 87, 150 racism, 144, 162
project, 4, 39, 44, 77, 80, 97, 129, 165 radius, 149
proliferation, 5 rainforest, 35, 48
protection, 4, 18, 21, 155, 162 reading, 143, 163
protective factors, 134, 140, 145, 147, 148, reality, 14, 22, 43, 140, 148
152, 153, 154, 156 reasoning, 49, 59
psychiatric disorders, 134, 138, 160 reception, 14
psychological distress, 137 recession, 163
psychologist, 168 reciprocity, 90, 146
psychology, 26, 150, 151, 157, 158, 168, recognition, 42, 79, 100
169, 170, 171 recognized tribe, 113
psychopathology, 145 recommendations, 117, 119, 134, 153, 156
psychosocial functioning, 160 recovery, 155
psychotherapy, 161 relatives, 15, 35, 45, 144
psychotic symptoms, 164 relevance, 32, 34, 40, 44, 125
PTSD, 133, 134, 137, 138, 139, 142, 151, reliability, 128
156 relief, 86, 119
puberty, 9 religion, 4, 13, 95, 136, 145, 150
public administration, 21 representativeness, 137
public health, 77, 79, 95, 123, 130, 140, 162 requirements, 21, 75, 99, 168
public service, 50 researchers, 50, 73, 99, 101, 108, 137, 140,
147, 152
resilience, 153
resistance, 4, 91, 116, 122, 166

184 Index
resources, 5, 13, 16, 17, 18, 19, 35, 37, 38, semi-structured interviews, 80, 88
46, 54, 59, 61, 77, 107, 115, 118, 136 sensitivity, 20
response, 116, 120, 134, 136, 141, 154 service provider, 114, 135, 150
responsiveness, 165 services, 50, 74, 77, 106, 113, 114, 122,
restaurants, 80, 82 135, 147, 148, 149, 150, 151, 154, 155,
retail, 80 158, 165, 168, 169
rhythm, 11 SES, 136
rights, 1, 3, 18, 19, 20, 21, 54 settlements, 75, 81
risk and protective factors, 134, 140, 148, sewage, 77
153, 154, 156 sex, 7, 125, 158
risk factors, 89, 140, 142, 145, 147, 151, sexual abuse, 138, 141, 156, 161, 164
152, 153 sexual orientation, 136
risks, 50, 68, 73, 89, 93, 97, 122, 125, 130, shamanism, 10
134, 140, 141, 142, 145, 147, 148, 151, shape, 13, 32, 33, 38, 53, 84
152, 153, 154, 155, 163, 164, 167, 169 shelter, 115, 136
rituals, 1, 2, 3, 7, 10, 11, 12, 13, 18, 20, 40 shortage, 120
roots, 24, 159 showing, 107, 110, 114, 153
routines, 9, 40 simulation, 129
rowing, 141 skin, 9
Royal Society, 103 slavery, 2, 4, 134
rubber, 5, 6 smoking, 136
rules, 19 smuggling, 19
rural areas, 35, 119 snacking, 81
snowmobiles, 80
soccer, 44, 48
S social adjustment, 27
social benefits, 16, 77
sadness, 102
social class, 95
scarcity, 17
social consequences, 92
scholarship, 121, 130
social group, 13
school, 15, 27, 29, 32, 34, 43, 44, 45, 46, 53,
social interaction, 53
68, 77, 101, 128, 141, 143, 144, 145,
social interactions, 53
158, 164, 169
social justice, 92, 134, 135
schooling, 43, 52, 59, 77
social network, 15, 61
science, 17, 23, 140, 154
social norms, 12
scientific knowledge, 16
social organization, 1, 7, 46
scope, 38
social problems, 163
security, 99, 102, 103
social relations, 7, 54
sedentary lifestyle, 72, 78
social relationships, 54
self-concept, 94, 102
Social Security, 115
self-destruction, 162
social services, 74
self-esteem, 143
social status, 143
self-study, 129
social stress, 165
seminars, 62

Index 185
social structure, 145 substance use, 133, 134, 137, 138, 144, 146,
social support, 106, 113, 115 151, 155, 157, 166
social welfare, 16 substance use disorders, 133, 134, 137, 138,
social workers, 150 157
socialization, 33, 36, 37, 67 substitutes, 78
society, 1, 3, 6, 7, 11, 12, 13, 14, 17, 20, 23, substitution, 122
37, 72, 78, 92, 143, 146 suicidal behavior, 139, 141, 144, 145
Sociocultural Barriers, 133 suicidal ideation, 140, 145
socioeconomic status, 112, 136 suicidality, 134, 154
sodium, 102 suicide, 133, 134, 135, 137, 139, 140, 141,
solution, 16, 21 142, 143, 145, 146, 147, 148, 151, 152,
South America, 3, 31, 34, 61, 62 153, 154, 156, 157, 158, 160, 161, 162,
South Asia, 96, 97 163, 164, 165, 166
South Dakota, 105, 109, 110, 126, 127, 128, suicide attempters, 162
130, 131, 137, 142 suicide attempts, 141, 142, 146, 147, 156
sovereignty, 4 suicide rate, 134, 139, 140, 142, 147, 161,
specialists, 17 163
species, 11, 17, 37, 48, 49, 50, 52, 77 supernatural, 11
spending, 81, 115 supervision, 169
spin, 17 surrogates, 116
spirituality, 117 survival, 5, 37, 119
stakeholders, 152 survivors, 169
states, 2, 4, 6, 14, 19, 20, 37, 75, 93, 99, sustainability, 28, 107, 152
106, 108, 126, 133, 149, 157, 158, 162, symptoms, 117, 120, 138, 157, 164, 167
163 synthesis, 53
statin, 110
statistics, 107, 126, 134, 156, 166
stereotypes, 118
T
stimulant, 18
teacher training, 28
stress, 32, 34, 53, 115, 124, 133, 134, 136,
teachers, 20, 28, 39, 43, 49
138, 141, 143, 146, 155, 157, 162, 164,
technical assistance, 63
165
techniques, 12, 38, 56
stress management, 115
technological advancement, 80
stressful events, 143
technological progress, 3
structure, 113, 145, 163
technologies, 14, 15, 16, 17
styles, 12, 53, 164
technology, 14, 15, 16, 17, 22, 23, 166
subjective well-being, 160
teens, 143
subsistence, 32, 35, 37, 38, 40, 50, 59, 67,
telephone, 129
72, 75, 77, 84, 86
tensions, 67
substance abuse, 77, 136, 142, 146, 151,
territorial, 5
156, 159, 164, 167, 169
territory, 6, 34, 75
Substance Abuse and Mental Health
testing, 162
Services Administration, 165
Thailand, 59

186 Index
therapeutic approaches, 151

therapeutic effect, 119
U
therapeutic goal, 120
U.S. economy, 142
therapy, 106, 110, 111, 114, 119, 120, 121
unemployment rate, 142
thoughts, 145
unhappiness, 102, 160
threats, 5, 19
uninsured, 149
time constraints, 82, 85, 86
United States (USA), 25, 64, 67, 68, 72,
tobacco, 10, 11, 34, 167
106, 108, 114, 124, 125, 126, 137, 143,
tones, 13
158, 160, 165, 166, 168
tourism, 38, 54
universe, 12, 144, 147
toys, 43
universities, 21, 26
trade, 75
updating, 54
traditional authorities, 41
urban, 35, 43, 107, 111, 114, 118, 122, 124,
traditional practices, 87, 117, 118, 146, 167
139, 143, 149, 154, 158, 159
traditions, 2, 7, 18, 71, 72, 74, 78, 79, 85,
urban areas, 114, 140, 143
87, 117, 118, 124, 144, 146, 151, 160
urban youth, 140
trainees, 99, 168
urbanization, 143
training, 28, 36, 37, 41, 63, 99, 151, 154,
US Department of Health and Human
169
Services, 107, 108, 126
traits, 2
uterus, 8
trajectory, 136
transcripts, 80
transformations, 8, 23, 31, 33, 36, 37, 43, V
52, 72, 77
transition to adulthood, 165 vacancies, 120
translation, 39, 86 vaccine, 111
transmission, 5, 23, 32, 33, 36, 38, 54, 59, vacuum, 141
73, 140 Valencia, 92, 122
transport, 6, 17, 45 validation, 28, 140
transportation, 114, 136, 149 valorization, 39
trauma, 134, 135, 136, 138, 144, 145, 151, valuation, 85
154, 156, 162, 164 values, 1, 4, 7, 12, 16, 38, 79, 85, 95, 97,
traumatic experiences, 135 115, 124, 143, 146, 147, 151, 154
treaties, 149 variables, 144
treatment, 111, 113, 115, 116, 117, 119, variations, 23, 95, 108, 116
123, 150, 151, 153, 166 vegetables, 12, 18, 81, 85, 101
tribal region, 137 vessels, 14
trustworthiness, 81, 90 victimization, 141, 145, 163
turnover, 150 victims, 6
type 2 diabetes, 93, 125 videos, 14
Vietnam, 138, 155, 157
violence, 141, 142, 146, 165, 168, 169, 170
visions, 12, 13, 36, 43, 49, 52, 53, 54
vitamin D, 100

Index 187
voiding, 83 WHO, 94, 167

vomiting, 85 withdrawal, 120
vulnerability, 27 withdrawal symptoms, 120
women, 7, 8, 9, 13, 22, 65, 71, 73, 74, 78,
80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 91,
W 92, 93, 94, 95, 96, 97, 102, 138, 139,
141, 142, 156, 157, 165, 168, 170
walking, 42, 45
wood, 5, 12, 13, 20, 83
war, 2, 4, 138, 157
workers, 150
Washington, 59, 91, 92, 111, 121, 122, 123,
workplace, 171
149, 155, 162, 163, 164, 165, 166
World War I, 77
water, 14, 44, 75, 77
worldview, 4, 72, 87
wealth, 18, 20
worry, 102
web, 96, 122
weight gain, 71, 74, 80, 82, 84, 85, 93
weight loss, 86, 93 Y
weight status, 89, 99
welfare, 16, 77 young adults, 138, 139, 156
well-being, 79, 86, 87, 115, 134, 135, 148, young people, 8, 14, 16, 32, 43, 54
152, 153, 158, 160, 168 young women, 85, 86
wellness, 72, 73, 87, 154, 160

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ISBN: 978-1-63485-665-2 (e-book)

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In this book, Chapter One addresses the diversity of Brazilian indigenous

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valuable contributions to the country's culture, besides examining some

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their particular worldview will encompass about Eeyou traditions and

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BRAZILIAN INDIGENOUS PEOPLES:

Eunice M. L. Soriano de Alencar

University of Brasilia, Brazil

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from professionals who work with indigenous peoples are presented to

Keywords: Brazilian indigenous diversity, Brazilian indigenous conquests,

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already established. To these practices, others followed throughout the 20th

BRAZILIAN INDIGENOUS PEOPLES:

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conquerors (Loebens and Carvalho, 2005). Similarly, it is not known precisely

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indigenous societies, similarly to the black plague in European countries

The relocation of communities to other regions, often accompanied

According to Koifman (2001), similar reports have been made by

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The Myky were victims of a so violent contact with the rubber

It is difficult to specify the current number of indigenous peoples in

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BRAZILIAN INDIGENOUS PEOPLES: DIVERSITY

The Brazilian indigenous peoples share many characteristics. However,

Many languages were and continue being spoken by indigenous peoples.

The language carajá has a few phonemes which are pronounced

Rituals, Myths and Practices

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During one night, an intense movement happened. The women of the

R. Soletti (personal communication, February 29, 2016) also described

The wedding in that ethnicity is characterized as clanic. This means

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The agreement is made when the mother promises her daughter in

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A central figure in all indigenous groups is the shaman, responsible for

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The shamans prefer to heal at night. One of the reasons is to

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Artistic expressions of various natures are common among Brazilian

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Lack of centralized political institutions and hereditary chiefs are common

Autonomy is something much valued by the indigenous and,

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BRAZILIAN INDIGEOUS PEOPLES IN CONTACT WITH

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