American Indian and Alaska Native violence prevention efforts: a systematic review, 1980 to 2018

Abstract

Background: Violence is a serious public health concern disproportionately experienced by American Indian and Alaska Native (AIAN) people. While the burden and impact of violence may be explained by the presence of risk factors among this group, AIAN communities benefit from unique protective factors and universal strategies which may be tailored with tribal adaptations. We sought to identify and explore violence prevention strategies specific to AIAN populations.

Methods: A review was conducted to systematically identify violence prevention programs, policies, and practices implemented in AIAN communities. We searched nine electronic databases and relevant gray literature released between January 1980 and June 2018. We included intervention-focused records targeting at least one violence topic area (child abuse/neglect, elder abuse, intimate partner violence, sexual violence, youth violence, and suicide) in a majority (> 50%) AIAN population.

Results: A total of 5220 non-duplicate records were screened, yielding 318 full-text records. After applying exclusion criteria, 57 records describing 60 program, policy, or practice implementations of 43 unique interventions were identified. All six violence types were represented, although more than half (58%; n = 25/43) focused on suicide prevention. Among suicide prevention programs, the most common strategies were identifying and supporting people at risk (80%; n = 20), teaching coping and problem-solving skills (56%; n = 14), and promoting connectedness (48%; n = 12). Two-thirds of the implementations (67%; n = 40/60) were in fully (100%) AIAN communities. Programs were implemented across many settings, though schools were the most common (35%, n = 21/60) setting. Of the 60 total implementations, a majority (80%; n = 48) were new approaches developed by and for AIAN communities, while the remainder were AIAN adaptations of programs previously created for non-AIAN populations. Most implementations (60%; n = 36/60) provided some evaluation data although less than half (45%; n = 27/60) reported evaluation results.

Conclusions: This review identified many violence prevention strategies specific to AIAN populations. While programs developed in one tribe may not be completely generalizable to others, shared tribal risk and protective factors suggest programs could be successful across diverse communities. Findings indicate there is a need to develop and evaluate violence prevention programs, policies and practices for AIAN populations.

Keywords: American Indian or Alaska Native; Suicide; Systematic review; Violence; Violence prevention.

Fig. 1

Flowchart of American Indian and Alaska Native Violence Prevention review 1980–2018. *Note Electronic databases searched include: Medline (OVID), PsycInfo (OVID), CINAHL (EBSCO), Sociological Abstracts (ProQuest), NTIS (EBSCO), Scopus, Criminal Justice Database (ProQuest), ERIC (ProQuest), ProQuest Central, Academic Search Complete EBSCO. Manually identified from hand review/search of non-indexed literature include: Google Scholar, IHS Primary Care Provider Journal and gray literature culled from ancestry and forward citing of included publications; Two year manual review of selected relevant and unindexed journals (International Journal of Indigenous Health; American Indian and Alaskan Native Mental Health Research; Washington University Journal of American Indian and Alaska Native Health). **Note The 57 records covered 60 unique implementations, as some studies reported multiple programs, policies and practices