Handbook of Psychology

Race/Ethnicity 551

Alcohol Abuse. Contact with European Americans has
caused dramatic increases in the use and changes in the func-
tion of alcoholic beverages among AI/AN societies (Abbott,
1996). Acute heavy drinking has been found to be prevalent
among Native Americans. In a study by Kimball et al. (1996)
of Northwest Indians, 40% of men and 33% of women re-
ported acute heavy drinking for the previous month.
Although much has been made about high rates of alcoholism
among Native Americans, the rate of alcohol metabolism has
been shown to be the same as in Caucasians (Gill, Eagle Elk,
Liu, & Deitrich, 1999). In addition, there is evidence that
older urban American Indians are not different from other
older people with respect to consumption of alcohol
(J. Barker & Kramer, 1996). Why then is there such preva-
lence of alcoholism among Native Americans? Further re-
search is necessary to address the issues of Native Americans
to gather a clearer picture for the creation and implementation
of culturally sensitive and effective prevention programs.

Social Support. Similar to “ndings in other ethnic mi-
norities, available research seems to suggest social support is
related to health among AI/AN populations. A study of
Navajo Indians• family support (family characteristics and
the amount of family support the patient perceived) at the
time of hospitalization showed greater perceived support was
associated with longer length of stay (R. Williams, Boyce, &
Wright, 1993). These results provide support for the notion
that social systems gain importance not from structure but
from their function (R. Williams, Boyce, & Wright, 1993).
The context in which Native Americans live also contributes
to the amount of social support. Frederickes and Kipnis
(1996) found that urban Native Americans reported receiving
less social support than rural Native Americans. Social sup-
port research on Native Americans shows social support is
related to health behaviors. Spangler, Bell, Dignan, and
Michielutte (1997) found that cigarette smoking was related
to separated or divorce status and low church participation. In
contrast, they also found that smokeless tobacco use was
associated with widowed marital status and having a high
number of friends.

Major Biobehavioral Risk Factors

One of the major challenges for Native Americans is to
balance their cultural values with the larger American soci-
etal values. The dif“cult interpersonal struggle to create this
balance causes some to commit suicide. Suicide rates have
been found to positively correlate with acculturation stress
and negatively with traditional integration (e.g., Lester,
1999).

Behavioral Treatment and Prevention Approaches for

Ethnic Minorities

Many protective factors are associated with the reduction of

health problems. There is growing evidence that behavioral

interventions could signi“cantly reduce the mortality and

morbidity burden experienced by minority populations.

Reducing morbidity through health promotion and disease

prevention could both improve the quality of life and lessen

the burden on the health care system. The challenge is to cre-

ate interventions that include information about nutrition and

promote physical activity in culturally appropriate ways (see

Buchowski & Sun, 1996).

In an effort to reduce chronic illness among ethnic minori-

ties, behavioral treatment and prevention programs are being

developed. There are dif“culties common to all interventions:

language, culture, and interactions between ethnicity and

SES. Dif“culties due to language differences include the

translation of materials in another language while maintaining

the meaning and signi“cance of the message being communi-

cated. Differences in culture preclude being able to simply

apply successful treatment and prevention programs across

minority groups. The interaction between ethnicity and SES

has been addressed by attempting to account for acculturation

but may also drive the need for ethnic by SES group-speci“c

programs.

Smoking Interventions

Successful smoking cessation exists but little is known about

the psychosocial factors that in”uence smoking cessation

among ethnic minorities (e.g., Nevid, Javier, & Moulton,

1996). While information alone is not enough to produce a

behavioral change as complex as quitting smoking, many re-

searchers believe that culturally appropriate messages about

the health consequences of smoking is a critical motivating

factor in a smoking cessation program (e.g., Marin et al.,

1990; Vander, Cummings, & Coates, 1990), and these

programs need strategies that re”ect ethnoculturally speci“c

features (Parker et al., 1996).

There are numerous areas of investigation and changes to be

made to create culturally appropriate smoking interventions.

These changes include, but are not limited to: (a) directing

efforts toward promoting cessation through proven behavioral

and pharmacological approaches, (b) making new smoking

prevention and cessation programs tailored for minorities by

focusing on smoking as a family-wide issue, (c) identifying

sources of cultural stress and adding stress-reduction tech-

niques to smoking cessation programs, (d) focusing on group-

speci“c attitudes and expectancies about quitting smoking, and