Culture is Prevention

Youth attend a sewing or beading group to learn their traditional language. A group of 

young women participate in a talking circle to discuss dating violence. A young man 

asks a traditional practitioner for a ceremony. A youth group drums at a powwow. A 

community holds a sweat or steam baths once a month. An elder visits a class room to 

share traditional knowledge with the youth. Is this prevention? 

Native Connections (NC) grantees know, from their own experience and from that of 

other grantees and partners, that culture is prevention. But how do we convince others 

– funders, tribal councils, community members? What, besides anecdote, demonstrates

this is true? How do we know that cultural practices are protective factors?

There’s research! Research shows that the risk 

for substance misuse and other adverse behaviors 

increases as the number of risk factors increases, 

while the more protectives that are in place 

reduce the risks.

1

 Categories of protective factors

positively associated with health and social 

outcomes for American Indian and Alaska 

Native (AI/AN) youth include: personal 

wellness, positive self-image, self-efficacy, 

familial and non-familial connectedness, positive opportunities, positive social norms, 

and cultural connectedness. Such factors positively influenced adolescent alcohol, 

tobacco, and substance use; delinquent and violent behavior; emotional health 

including depression, suicide attempt; resilience; and academic success.2

 In a study of 

suicide attempts among AI/AN youth, the authors concluded that increasing protective 

factors was more effective at reducing the probability of a suicide attempt than was 

decreasing risk factors.

3

1 https://youth.gov/youth-topics/substance-abuse/risk-and-protective-factors-substance-use-abuse-and-dependence

2 Journal of Primary Prevention. 2017 Apr;38(1-2):5-26. doi: 10.1007/s10935-016-0455-2. Identifying Protective Factors 

to Promote Health in American Indian and Alaska Native Adolescents: A Literature Review, Henson M1, Sabo 

S2, Trujillo A3, Teufel Shone N4. 

3 Borowsky, I. W., Resnick, M. D., Ireland, M., & Blum, R. W. (1999). Suicide attempts among American Indian and 

Alaska native youth: Risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 153(6), 573-580.
2 

We see NC grantees promoting and creating strengths-based programs for youth across 

the country. One grantee will offer cultural workshops to 100 community members, 

that include traditional cooking, gardening and arts and crafts. Another grantee plans 

to increase cultural pride and self-awareness by facilitating youth group meetings 

which promote a sense of self, community, and well-being. Another grantee is holding 

regular traditional storytelling events and traditional games for youth. The Cheyenne 

and Arapaho Tribe, a sub-recipient of Southern Plains Tribal Health Board, sum it up 

with this marketing message, “Tradition, not Addiction.” Some grantees are combining 

cultural activities with evidence-based practices such as Project Venture and/or Question,

Persuade, Refer (QPR) or Applied Suicide Intervention Skills Training (ASIST). NC 

grantees know that cultural practices and events can build connectedness, model positive 

social norms, personal wellness, and contribute to the other positive outcomes listed above. 

Cultural values are the threads that tie 

one tribe’s or village’s practices to 

other indigenous practices; they are 

also the links between the past and the 

present. They align with what the 

research tells us works in prevention. 

In community gatherings we see the

traditional values of generosity and 

belonging. In activities that connect 

youth and elders, the value of 

respecting and honoring the wisdom 

and history that elders carry is 

demonstrated, as well as providing a sense of belonging for the youth. Storytelling and 

story circles honor traditional wisdom, but also give participants the opportunity to 

speak their own truth, honor their identity, and learn values and skills that contribute to 

self-efficacy. It is the transmission of these values that lays the foundation for resilience. 

But how do you tell the story of the cultural activities being implemented in your 

community? How do we know they are working? There are current and historic 

problems with research and evaluation in AI/AN communities. Indigenous 

communities are concerned that most research has focused on risk factors, which 

encourages stigmatization. Because of this many AI/AN communities are drawn to 

strengths-based models. These approaches emphasize the protective role of culture, 

cultural processes, and activities in prevention. They are also drawn to Community 

Based Participatory Research (CBPR) as a type of research that is more respectful, 
3 

ethical, sympathetic, and useful than research associated with exploitation and 

colonization.4

CBPR is a collaborative approach to research that, in an unbiased way, involves all 

partners in the research process and recognizes the unique strengths that each brings. 

CBPR begins with a research topic of importance to the community and has the aim 

of combining knowledge with action and achieving social change to improve health 

outcomes and eliminate health disparities.

5

 It has also been used to increase the 

capacity of community members to use research to further the goals of the 

community. It will ultimately lead to legitimizing cultural interventions in the eyes of 

the larger research community and funders who rely on “research-based” criteria to 

fund activities. 

One group of researchers have described 

CBPR as having the following 

characteristics: 

• Emphasizes protective factors,

resilience, and well-being

• Develops community capacity and

collaboration on design of local

programs

• Conceptualizes suicide as a social

problem, not an individual problem

• Focuses on community-level factors,

not individual-level factors6

Future work products will expand on how 

to implement CBPR in your community, 

starting with determining what outcomes 

the community is interested in tracking and 

then proceeding to planning and 

developing the measures and instruments 

that will best meet the needs of the community and demonstrating the effectiveness of 

the interventions being implemented by the grantee’s Strategic Action Plan. 

“Expanding on this community-level 

perspective, it is imperative to develop 

interventions capable of increasing 

community health as well as individual 

well-being. To date, suicide prevention 

intervention research focused on 

producing standardized interventions 

has had disappointing results. To some 

extent, this may reflect difficulties in 

implementation. We argue, therefore, 

that focusing on the processes of 

change through community 

engagement and participatory inquire 

may help identify and address the 

limitations of current interventions. 

Such an approach to research ensures 

that there is always knowledge gained, 

whatever the outcome.” 

Wexler, L. et. al., Advancing Suicide 

Prevention Research with Rural American 

Indian and Alaska Native Populations, Am J 

Public Health. 2015 May; 105(5): 891-899 

4 Smith LT. Decolonizing Methodologies: Research and Indigenous Peoples. London, England: Zed Books; 1999.

5 W.K. Kellogg Foundation Community Health Scholars Program, 

http://www.kellogghealthscholars.org/about/community.php

6 Wexler, L. et. al., Advancing Suicide Prevention Research With Rural American Indian and Alaska Native 

Populations, Am J Public Health. 2015 May; 105(5): 891–899.