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Self-reported Illness Experiences and Psychosocial Outcomes for Reservation-Area American Indian Youth During COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How did American Indian youth who live on or near reservations experience the COVID-19 pandemic?

Findings  This cross-sectional study among 2559 American Indian students in grades 6 through 12 found that approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection, a higher rate than for all cases nationally and for children nationally, and three-quarters of the sample reported someone close contracting COVID-19, while more than one-quarter reported someone close dying from COVID-19. Regarding perceived psychosocial impacts, COVID-19 was associated with strained friend relationships, lower school engagement, and less social connectedness, although more than 60% of students reported feeling no change or a decrease in negative emotions, such as sadness and anxiety.

Meaning  These findings suggest that although COVID-19 mortality and morbidity rates were high on American Indian reservations, psychosocial impacts were complex and many students were resilient in the face of the pandemic.


Importance  Impacts of COVID-19 on reservation-area American Indian youth are unknown and may be substantial owing to the significant COVID-19 morbidity and mortality experienced by American Indian populations.

Objective  To measure self-reported illness experiences and changes in psychosocial factors during the COVID-19 pandemic among reservation-area American Indian youth.

Design, Setting, and Participants  This cross-sectional study included a random sample of US schools on or near US Indian reservations during Spring 2021, stratified by region, with students in grades 6 to 12 completing cross-sectional online surveys. All enrolled self-identifying American Indian students in grades 6 to 12 attending the 20 participating schools were eligible to be surveyed; participants represented 60.4% of eligible students in these schools. Data were analyzed from January 5 to July 15, 2022.

Exposures  Onset of the COVID-19 pandemic.

Main Outcomes and Measures  Outcomes of interest were COVID-19 self-reported illness outcomes for self and family and close friends; perceived changes in family and friend relationships, school engagement, social isolation, and other psychological factors since the COVID-19 pandemic began; and worry over COVID-19–related health outcomes.

Results  A total of 2559 American Indian students (1201 [46.9%] male; 1284 [50.2%] female; 70 [2.7%] another gender; mean [SD] 14.7 [8.9] years) were included in the analysis. Approximately 14% of the sample reported having had a test result positive for SARS-CoV-2 infection (14.3% [95% CI, 11.4%-17.6%]), a higher rate than for all cases nationally at the time of the survey. Regarding prevalence of COVID-19 among family and close friends, 75.4% (95% CI, 68.8%-80.9%) of participants reported having at least 1 family member or friend who had contracted COVID-19, while 27.9% (95% CI, 18.8%-39.3%) of participants reported that at least 1 family member or close friend had died of COVID-19. Regarding psychosocial impacts, COVID-19 was associated with strained friend relationships (eg, 34.0% [95% CI, 28.4%-40.0%] of students reported worry over losing friends), lower school engagement, and less social connectedness (eg, 62.2% [95% CI, 56.7%-67.4%] of students reported feeling less socially connected to people), although more than 60% of students also reported feeling no change or a decrease in negative emotions. Males were less likely to report perceived negative impacts, especially for negative emotions such as sadness (29.2% [95% CI, 23.3%-35.9%] of males vs 46.1% [95% CI, 43.9%-48.3%] of females reported feeling more sad) and anxiety (21.8% [95% CI, 18.2%-25.8%] of males vs 39.2% [95% CI, 34.1%-44.6%] of females reported feeling more anxious).

Conclusions and Relevance  This cross-sectional study provides novel insight into the perceived experiences of reservation-area American Indian youth, a population at uniquely elevated risk of poor health status and health care access, during the COVID-19 pandemic. Although mortality and morbidity rates from COVID-19 were high on American Indian reservations, student reports of psychosocial impacts were complex and suggest many students were resilient in the face of the pandemic. These findings could be used to understand and address the challenges facing American Indian youth due to the pandemic and to guide future research that examines the factors and processes associated with the reported outcomes.

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Article Information

Accepted for Publication: July 30, 2022.

Published: September 14, 2022. doi:10.1001/jamanetworkopen.2022.31764

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Stanley LR et al. JAMA Network Open.

Corresponding Author: Linda R. Stanley, PhD, Colorado State University, 335 Behavioral Sciences Building, Campus Delivery 1879, Fort Collins, CO 80523-1979 (linda.stanley@colostate.edu).

Author Contributions: Dr Stanley had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Stanley, Swaim, Prince.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Stanley, Prince.

Critical revision of the manuscript for important intellectual content: Crabtree, Swaim, Prince.

Statistical analysis: Stanley, Prince.

Obtained funding: Stanley, Swaim, Prince.

Administrative, technical, or material support: Swaim.

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (grant No. R01 DA003371-32A1S1).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Stacy Biggerstaff, MS, managed all of the data for this study. Allison Burford, MA, coordinated all relationships and procedures with all participating schools. Erin Whipple, BA, assisted with grant management. All individuals were affiliated with Colorado State University and were not compensated for this work outside their normal salaries.

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