American Indian Statistics in the U.S. 2000 Census
- Population Statistics
- A Morbidity Statistic related to Children
- Substance Abuse Statistics
- Peer Groups and Risk-Taking Behaviors
- Physiological Research
According to the 2000 U.S. Census:
– – The last US census tells us there are 4,119,301 American Indians and Alaska Natives in the United States and 562 federally funded tribes. Approximately 75% live outside the reservation, with about 55% now residing in metropolitan areas. Only about 25% live on reservations. Many have chosen to leave.
– – As much as 45% of reservation residents are non-Indian. In fact, on 30% of the reservations, the number of non-members is equal to or greater than the number of tribal members. The incidence of inter-racial marriage is high. The Montana Supreme Court, in Skillen v. Menz, wrote, “…interracial marriages are a fact of life, and, as with other marriages, so are interracial divorces and custody disputes over the children of those marriages.
Morbidity Statistic related to Children:
Dec. 7th 2003 edition of the Oregonian:
– – federal statistics show that for years, the 1.5 million people who live on or near reservations have seen children die at about twice the national rate. Quoted in the article is Jon Perez, director of behavioral health at the federal Indian Health Service, who said, “What you have are developing countries right in the heart of the United States. Each has a history of neglect and a legacy of trauma that explains these disparities. We need this history not as excuses for the disparities but as a need to intervene.”
Substance Abuse Statistics:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES: From: Substance Abuse and Mental Health Services Administration Center for Substance Abuse Prevention www.samhsa.gov. Prevention Alert, Volume 5, Number 16 November 22, 2002
Sources: SAMHSA’s National Household Survey on Drug Abuse, Detailed Tables, 2000; Health Promotion and Substance Abuse Prevention Among American Indian and Alaska Native Communities: Issues in Cultural Competence, SAMHSA, 2001. Online article 11 Jan. 2006 <http://www.health.org/govpubs/prevalert/v5/10.aspx>
– – Tobacco use by young people 12 to 17 years who are American Indian or Alaska Native is very high—31.3 percent have used some form of tobacco in the past month, almost twice the rate of Whites and three times that of Hispanics. These disparities level off some in the “college” years (18 to 25), when half of all Whites and Native Americans use tobacco in the past month. The gap widens again after 26, when 38 percent of Americans Indians/ Alaska Natives smoke cigarettes regularly, followed by 30 percent of mixed race individuals and 26 percent of Whites.
– – From 1999 to 2000, most major ethnic groups decreased their current (past month) use of illicit drugs, except American Indians and Alaska Natives, whose use jumped in that one year alone 21 percent (from 10.4 percent to 12.6 percent). By comparison, 6.4 percent of Whites are current illicit drug users. Much of this is due to excessive use of marijuana; Native American youth use of so-called “hard” drugs other than marijuana has actually declined 20 percent in that period. Nearly half of Native American youth ages 12 to 17 will have tried an illicit drug, while only a quarter of Blacks will have done so and about 28 percent of Whites. Current marijuana use is common among young Native Americans—20 percent do it (vs. 8 percent of White youth, 7 percent of Hispanic youth, and 5 percent of Black youth). On the positive side, inhalant use is down; however, prescription drug misuse is twice the rate of Whites.
– – For those over the age of 12 in 2000, the percentage of “current drinkers” (those who drank in the past month) among the 4 million American Indians and Alaska Natives (35 percent) is much lower than both Whites (51 percent) and Hispanics (40 percent), and only slightly higher than Blacks (34 percent). However, 19 percent of American Indian youth 12 to 17 are past month drinkers—the highest of the major ethnic groups (though the White figure is close—18 percent). For persons over 26, the Native American past month rate is actually the lowest of all. The alcohol abuse problem among American Indians/Alaska Natives appears to be concentrated in the young and the so-called “heavy drinkers” over 26. Binge drinking rates (drinking five or more drinks on one occasion at least once a month) for youth 12 to 17 are highest for Native Americans (12.8 percent do it, versus 11.9 percent for Whites and 11 percent for Blacks). For Native youth who practice “heavy alcohol use” (defined as binge drinking five times a month or more), the rate 1999 to 2000 has declined significantly, from 4.6 percent to 2.9 percent (rates were at least twice as high a decade ago). But after 26, the 7.4 percent rate of heavy alcohol users is highest among Native Americans, and is increasing, while most other groups’ severe use rates are stable or declining.
Effects of Substance Abuse:
Over the years, the effect of substance abuse on American Indian/Alaska Native mental and physical health has been devastating. For the age group 25 to 34, American Indian males die almost three times more frequently than their non- Indian counterparts from motor vehicle crashes; they are twice as likely to commit suicide; they are seven times more likely to suffer from alcohol-related problems, such as cirrhosis of the liver. Alaska Native males ages 15 to 24 have a suicide rate 14 times the national average. Fetal alcohol syndrome (FAS) occurs among Alaska Native newborns at twice the national average, and 73 percent of the women who give birth to these FAS children report being sexually abused as a child.
Peer Groups and Risk-Taking Behaviors:
Ardy SixKiller Clarke, Social and Emotional Distress Among American Indian and Alaska Native Students: Research Findings
EDO-RC-01-11 (January 2002) <http://www.indianeduresearch.net/edorc01-11.htm>
Ardy SixKiller Clarke is a professor of educational leadership and the Director of the Center for Bilingual/Multicultural Education at Montana State University-Bozeman and is currently involved in research that examines the influence of violence on learning.
A 2001 study by the U.S. Department of Health and Human Services (USDHHS) reported the following rates of participation in a variety of high-risk behaviors among AI/AN youth aged 12 to 17 years in 1999-2000:1
- Illicit drug use was more than twice as high (22.2%) as the national average (9.7%).
- Binge alcohol use was higher (13.8%) than the national average (10.3%).
- Heavy alcohol use was higher (3.8%) than the national average (2.5%).
- Driving under the influence of illicit drugs or alcohol in the past year was slightly lower (10%) than the national average (11.2%).
- Use of cigarettes was more than twice as high (27.2%) as the national average (13.4%).
- Getting into at least one serious fight at school or work in the past year was higher (22.1%) than the national average (19.9%).
- Taking part in at least one group-against-group fight in the past year was higher (22.4%) than the national average (16.1%).
- Carrying a handgun at least once in the past year was about the same (3.3%) as the national average (3.2%).
As these figures demonstrate, illicit drug use among AI/AN youth continues to be far more common than among their non-Indian peers. Beauvais reported in 1996 that, although overall drug use decreased from its high levels of the 1970s, about 20% of Indian adolescents continued to be heavily involved with drugs—a proportion that had remained steady since 1980. Alcohol use varies considerably across reservations and tribes. Overall, however, alcohol use appears to be a less severe problem than illicit drug use, and while still a cause for concern, is not as severely out of sync with the national average as is the rate of drug use. However, aggregated data can disguise acute problems in some locations by balancing them with successes in others. Data point to a pattern of reckless living among youth in Indian Country. Motor vehicle and other accidents are the leading cause of death among AI/AN persons aged 15-24, whose rate of death due to accidents is almost three times higher than the rate for the total U.S. population (USDHHS, 1999). Among youth attending Bureau of Indian Affairs (BIA) schools, there is lower-than-average usage of seatbelts, motorcycle helmets, and bicycle helmets (Shaughnessy, Branum, & Everett-Jones, 2001).
Data also indicate the presence of despair. Suicide is the second leading cause of death for AI/AN youth in the 15-24 age group; currently the suicide rate is 2.5 times higher for AI/AN people than the combined rate for all races in the United States (USDHHS, 1999). In the BIA study, 19% of AI/AN high school youth had seriously considered suicide during the preceding year. Although still a strong cause for concern, this statistic does represent an improvement over the 29% reported in the 1994 survey (Shaughnessy, Branum, & Everett-Jones, 2001). National studies show homicide and legal intervention are the third leading cause of death for Indian youth (ages 15-24); the homicide rate among American Indians is 1.2 times that of the general U.S. population (USDHHS, 1999).
While there is considerable anecdotal evidence of increasing gang activity among AI/AN students, no national studies provide reliable data about levels of participation. In a study based on a convenience sample of nearly 14,000 youth in 50 tribes located in 12 states, 15% of reservation American Indian youth reported some level of gang activity, with younger teens participating at higher levels than older teens (Children, Youth and Family Consortium, 1992). A more recent study conducted on the Navajo Reservation concluded there was wide variability among youth who identified themselves as gang members. Some gangs were simply street-corner groups while others had hardened. Sociodemographic conditions were a strong factor in creating a context for gang formation around a small number of antisocial individuals. The researchers concluded that “gang prevention is not simply, or even fundamentally, a law enforcement issue. It is a public health issue in the broadest sense” (Henderson, Kunitz, & Levy, 1999, p. 258).
Several studies have provided evidence that families with strong traditional values positively impact the academic success of AI/AN students (for a review, see Demmert, 2001). However, for many AI/AN families, the interruption in the intergenerational transmission of traditional culture imposed by the Indian boarding school era—which separated generations of American Indian children from their tribes and families—continues to have effects today. Many American Indian women missed out on role models for nurturing and child rearing (Ing, 1992). Further, some families continue to feel alienated from mainstream educational purposes and institutions, which reduces their involvement in their children’s educations (Cummins, 1989). A final family factor affecting educational outcomes of AI/AN students is the high incidence of Indian households headed by women (45%), 42% of whom were younger than 20 when they had their first child (LaFromboise, Choney, James, & Running Wolf, 1995). These factors not only contribute to the incidence of poverty in AI/AN families but also increase the demands on female heads of households, who may lack time and resources for active involvement in the education of their children.
While there are no recent data about AI/AN drop-out rates, national studies from a decade ago indicated that Native student rates were higher than other groups in America (Hillabrant, Romano, Stang, & Charleston, 1991). It is important to look beyond the youth themselves and examine conditions in the schools they attend. Bowker (1993) reports that students who drop out cite several school-related problems: failure or inability to get along with teachers, dislike of school, inability to get along with other students, boredom, feelings of not belonging, and suspension. According to Caine and Caine (1997), students who are confronted with racist threats on a regular basis often lose a positive sense of cultural identity and begin a process of downshifting, which eventually leads to dropping out. Similarly, Irvine (1990) suggests that when there is a cultural incongruity between the school and the student, miscommunication and confrontation often occur among students, teachers, and families, resulting in hostility, alienation, and eventual dropping out.
Many AI/AN youth live in communities that continue to experience long-term economic and social distress. High rates of alcoholism, drug abuse, domestic abuse, child neglect, substandard housing, and lack of job opportunities are common conditions in Indian communities. Violence on Indian reservations is often regarded as the norm. The dimensions of this phenomenon are described in a recent Department of Justice study, American Indians and Crime (Greenfield & Smith, 1999), which reported that the rate of violence in Indian Country is well above that for all other ethnic groups and more than twice the national average.
Multiple studies have shown the adverse effects of chronic exposure to violence on a child’s ability to learn (see Massey, 1998, for a concise review). Massey, reporting research by Prothrow-Stith and Quaday (1995), points out that
Learning itself is an essential tool for violence prevention. Children who achieve in school and develop important reading, critical thinking, problem solving, and communication skills are better able to cope with stressful and perhaps dangerous situations. Also, academic achievement enhances the development of a positive self-esteem and self-efficacy, both of which are necessary for children to experience emotional well-being and to achieve success. (p. 2)
Unemployment, which is often associated with high levels of crime and substance abuse, is high in Indian communities, ranging up to 85% on some reservations (U.S. Department of the Interior, 1999). Nearly a third (31.6%) of Indian people live below the poverty level, compared to 13.1% of the general population (USDHHS, 1999). Apple (1996) refers to situations of high unemployment and poverty as “a reality of crisis, an economy that increases the gap between rich and poor” (p. 71) and points out that in poor communities, schools are poorer and less able to motivate students and their parents.
Addressing root causes of conditions that put AI/AN students at risk is the best long-term solution to challenges facing youth and communities. However, even in communities where dangers remain pervasive and severe, measures can be taken to protect children exposed to community and family distress. Research on resiliency has shown the importance of individuals and organizations in providing protection and hope to young people, while helping them to “find the good path” and lead fulfilling lives (Benard, 1997; Bergstrom, Cleary, & Peacock, 2002). These protective individuals and organizations can be associated with any or all of the four domains just discussed—peer groups, families, schools, or communities.
1The statistics cited here are means for the years 1999 and 2000 combined.
The Minneapolis Star and Tribune, April 25, 2004, offered the following statistics for one Reservation county:
*Cass County, where most of the reservation’s people live, ranked last among 77 Minnesota counties in a 1999 government study that measured the health and safety of children.
*In 2002, Cass County had the state’s highest percentage of children living in foster homes and other county-supervised care. Most of them were Indians from the reservation, taken away from their parents, or given up by them, because of abuse, neglect or delinquency.
*A statewide study of ninth-graders in the mid-1990s found that Cass County had the highest rate of heavy drug and alcohol use and the highest rate of alcohol abuse within their families. The county also ranked first in numbers of people admitted to detoxification centers.
*Death comes earlier here. In Minnesota, Indians’ average life expectancy is about eight years less than for the population as a whole.
According to one social service source quoted in the December 10, 1999 edition of the Native American Press, “Some of the mothers that are losing their children first became pregnant when they were only 12 years old. They often have more children with other men. These situations often lead to their older children being abused by the step-father, or the parents live-in relatives.” The source also claimed that some Indian programs in Minneapolis actually try to help parents avoid county drug screenings.
Ann N. Dapice, Ph.D., Clark Inkanish, ICADC, Barbara Martin, B.S., and Pam Brauchi, MHR, LPC., Killing Us Slowly: When We Can’t Fight and We Can’t Run 2002
In the American Indian community, the experience of reading current Indian Health Service statistics on death and disease among Indians is similar to that of reading about a third world country in the news. …Even though many know that Indians suffer greatly from alcoholism and Type II Diabetes, our work demonstrating the physiological relationship between the two was, unexpectedly, groundbreaking. The other high morbidity and mortality statistics can be understood in the same way.
Accidents, homicide and suicide kill Indian children and youth in far larger numbers than any other racial group. Later in life, heart disease, chronic liver disease/cirrhosis, and diabetes kill Indian adults greatly out of proportion to other groups. Physiologically and socially, these causes of death are all related to alcoholism, smoking, and other addictions such as those to food. Lung cancer is increasing among Indians but even though Indians smoke more than any other group (Indians-40%, all races-25%), they have usually suffered and died of other maladies before developing lung cancer.
… Genetic differences in alcoholism have long been noted. A number of researchers have demonstrated that EEG patterns are different in alcoholics and non-alcoholics. It has been determined that the differences are not that of alcohol use but that these differences are present at birth in identical twins. Individuals at risk for alcoholism can be differentiated on the basis of their EEG alpha activity. Alcoholics have greater increases in slow alpha activity and greater decreases of fast alpha activity after use of alcohol. A reduced P300 wave is a good predictor of alcoholism. Recent studies show that alcoholism relapse can be predicted by brain waves. Alcoholics are said to use alcohol, sugar, nicotine, and caffeine in vain attempts to quiet their irritable brain waves.
The impact of stress:
More recently understood however, is the reality of what happens to the body and brain during high or chronic levels of stress. The adaptive mechanism known as “fight or flight” that allows people to protect themselves in emergency conditions becomes destructive when people are not allowed to fight or flee, or when the stress becomes chronic. Cortisol, produced during these times, becomes toxic to the body and the brain, killing brain cells and leaving depression in its wake.
Ray Smith, Ph.D., … has noted that ..humans survive periodic threats and challenges by maintaining homeostasis-a delicate, dynamic equilibrium. If that harmony is disrupted, neural and biochemical events in the brain, the endocrine, and immune systems are jolted into action to counter the effects of the physical or psychological stressor-and to reestablish homeostasis. If such homeostasis isn’t reset, debilitating illness results. When we are threatened, a series of responses occur-our physiological processes which have to do with conservation and restoration of energy are put on hold, and the processes which prepare us for fear, fight and flight takes over resulting in the release of cortisol into the bloodstream. Once the threat is addressed, the body returns to homeostasis and the brain is relaxed through the inhibition of several chemicals (the neurotransmitters serotonin, norepinephrine and dopamine). If the threat is not removed, a stress cycle develops where more cortisol is produced causing further problems.
Now there is a permanent state of stress homeostasis which impairs our immune systems, decreases our bone density, weakens our muscles, increases heart and vascular diseases, and lowers our resistance to diabetes.
After prolonged exposure to severe stress the body secretes internally produced opium-like substances which inhibit pain and reduce panic. Memory is impaired in animals when they are no longer able to influence the outcome of a dangerous situation. The “freeze” response and panic interfere with memory processing-the internally produced adrenalin and opium-like substance interfere with the storage of experience in memory. This protective mechanism may serve to keep the individual from consciously remembering an event but often results in confusion regarding related emotional pain and behavior. It can also prevent learning from the experience.
Post traumatic stress disorder:
Post traumatic stress disorder (PTSD) resulting from traumatic events continues the effects of the stress over time, continuing a cycle of cortisol production with ongoing depression. PTSD patients typically continue to re-experience a trauma, avoid stimuli associated with the incident and feel numb. They demonstrate hyperarousal, irritability, insomnia and inability to concentrate.
In circumstances where we are under someone else’s power with little of our own-whether a child in an abusive family or in the extreme situation of genocide and slavery-we cannot fight or flee so stress becomes chronic and the levels of cortisol remain elevated. At some point in time we may no longer be able to produce the cortisol needed for times when it might actually help with fight or flight actions that are appropriate to a situation. Not only can we ourselves become cortisol depleted, but children born to mothers with low cortisol levels have often been found to have low cortisol levels as well. The related behavioral effects can be seen in situations of hopelessness and poverty where people no longer seem to be able to fight for their survival, leading to assumptions that they are lazy and don’t care-as opposed to depressed, hopeless-and cortisol-less!
When powerlessness has been sufficiently abusive and lasted for a long enough time, an individual develops an expectation of ongoing abuse and even when moved to a safer situation often has great difficulty responding in any other way. New situations are interpreted as the same as those in the past so that fear continues to stimulate what small levels of cortisol may still be produced.
Eduardo and Bonnie Duran, in their book, Postcolonial Psychology, write that American Indians experience intergenerational PTSD similar to that of survivors of the Jewish Holocaust. The authors note that not only did the survivors of the Jewish Holocaust suffer from PTSD but many of their children did as well-even though they had not directly experienced the events of the Holocaust. Normal human development is “mutilated by the traumas of loss, grief, danger, fear, hatred, and chaos” write the Durans, and dysfunctional patterns of behavior come to be seen as part of Native American tradition-the alcoholism, child abuse, suicide, and domestic violence (p. 35).
(Editors note: however, we do NOT see the same state of hopelessness and lethargy in Jewish communites today that we are seeing within Reservation communities. On the contrary, todays’ Jewish communities have a reputation for being vital and ambitious. Therefore, it would seem there is some other factor affecting Indian Country. LM)
Harvard researchers Martin Teicher and Carl Anderson have demonstrated through brain imaging technology that there are three major changes observed in the brains of adults who were abused as children: 1) Limbic irritability with increased incidence of clinically significant EEG abnormalities. 2) Deficient development of the left hemisphere of the brain (throughout the cerebral cortex and hippocampus). 3) Deficient integration of the left and right hemispheres of the brain with diminished development of the middle portions of the corpus callosum that serves as a bridge connecting the left and right brain. These changes do not require actual physical damage to the head but are most often the result of neglect, emotional and sexual abuse.
Anderson found that repeated abuse affects the blood flow and function of the cerebellar vermis, a part of the brain implicated in the coordination of emotional behavior which is strongly affected by alcohol, cocaine, and other drugs of abuse and may help regulate dopamine, a neurotransmitter that is critically involved in addiction. Anderson and colleagues focused on this part of the brain because it is “exquisitely sensitive to stress hormones” and develops slowly. “Damage to this area of the brain resulting from neglect, emotional and sexual abuse may cause an individual to be particularly irritable and to seek external means, such as drugs or alcohol, to quell this irritability,” said Anderson.
Stress and substance abuse:
As noted by the National Institute of Drug Abuse (NIDA), studies in the Journal Psychoneuroendocrinology indicate: 1) Stress and cortisol sensitize animals for drug-seeking behaviors and facilitate self-administration. 2) Animals that are under-aroused and have low levels of cortisol are more prone to develop drug-seeking behaviors. 3) Severe stress early in life induces a series of physiological, neurobiological, and hormonal events that result in dysregulation of biological reward pathways in the central nervous system and in stress response systems; these changes seem to prompt self-administration of drugs and alcohol later in life. 4) Prenatal exposure to stress and drugs predispose animals to drug-seeking behaviors in adulthood. 5) Post traumatic stress disorder is a risk factor for substance abuse. 6) The administration of cocaine to humans causes similar physiological reactions such as secretion of adrenalin and cortisol, and psychological reactions similar to arousal caused by stress.
Researchers at the Scripps Research Institute in California observed a few years ago that heavy drinking not only depletes the brain’s supplies of substances necessary for feelings of wellbeing and pleasure (dopamine, serotonin, GABA, and opioid peptides), but it also promotes the release of cortisol. This release of cortisol causes tension and depression which in turn causes the individual to drink more which leads to an ongoing vicious cycle. In a similar way, carbohydrate craving is self medication, with resulting physical destruction.
Once adaptive, but no longer:
Like insulin, cortisol levels may be high or low. There are physical and emotional consequences to both. Chronic over-stimulation of insulin (from too many carbohydrates) and cortisol (from too much stress) may cause depletion with negative impact. The production of insulin and cortisol are both important mechanisms to survival. The production of insulin in response to the ingestion of carbohydrates once allowed fat storage in the body for protection during long winter months or times of famine. In some parts of the world where famine still exists, this process still assists in survival. When refined fast foods are a constant, this is no longer the case. Similarly, the stress response was once important to survival, now that is rarely true.
For references and research information, contact the authors at T. K. Wolf, Inc.,
Apple, M. W. (1996). Cultural politics and education. The John Dewey Lecture Series. New York: Teachers College Press.
References for Ardy SixKiller Clarke, Social and Emotional Distress Among American Indian and Alaska Native Students: Research Findings
- Beauvais, F. (1996). Trends in drug use among American Indian students and dropouts, 1975-1994. American Journal of Public Health, 86(11), 1594-1598.
- Benard, B. (1997). Turning it around for all youth: From risk to resilience (ERIC/CUE Digest, No. 126). New York: ERIC Clearinghouse on Urban Education. (ERIC Document Reproduction Service No. ED412309)
- Bergstrom, A., Cleary, L. M., & Peacock, T. (2002). The seventh generation: Native students speak about finding the good path. Charleston, WV: ERIC Clearinghouse on Rural Education and Small Schools.
- Bowker, A. (aka Ardy SixKiller Clarke). (1993). Sisters in the blood: The education of women in Native America. Newton, MA: WEEA Publishing Center.
- Caine, R. N., & Caine, G. (1997). Education on the edge of possibility. Alexandria, VA: Association for Supervision and Curriculum Development.
- Children, Youth and Family Consortium. (1992). The state of Native American youth health. Minneapolis: University of Minnesota Health Center, Division of General Pediatrics and Adolescent Health. Retrieved January 18, 2002, from http://www.cyfc.umn.edu/Diversity/nativeamer.html
- Cummins, J. (1989). Empowering minority students. Sacramento, CA: California Association for Bilingual Education.
- Demmert, W. G., Jr. (2001). Improving academic performance among Native American students: A review of the research literature [Electronic version]. Charleston, WV: ERIC Clearinghouse on Rural Education and Small Schools.
- Greenfield, L. A., & Smith, S. K. (1999). American Indians and crime. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics. Retrieved January 18, 2002, from http://www.ojp.usdoj.gov/bjs/pub/pdf/aic.pdf
- Henderson, E., Kunitz, S. J., & Levy, J. E. (1999). The origins of Navajo youth gangs. American Indian Culture and Research Journal, 23(3), 243-264.
- Hillabrant, W., Romano, M., Stang, D., & Charleston, G. M. (1991). Native American education at a turning point: Current demographics and trends. Washington, DC: U.S. Department of Education. Indian Nations at Risk Task Force. (ERIC Document Reproduction Service No. ED343756)
- Ing, N. R. (1991). The effects of residential schools on Native child-rearing practices. Canadian Journal of Native Education, 18(Suppl), 65-118.
- Irvine, J. J. (1990). Black students and school failure: Policies, practices and prescriptions. Westport, CT: Greenwood Press.
- LaFromboise, T. D., Choney, S. B., James, A., & Running Wolf, P. R. (1995). American Indian women and psychology. In H. Landrine (Ed.), Bringing cultural diversity to feminist psychology: Theory, research, and practice (pp. 197-349). Washington, DC: American Psychological Association.
- Massey, M. S. (1998). Early childhood violence prevention (ERIC Digest). Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC Document Reproduction Service No. ED424032)
- Prothrow-Stith, D., & Quaday, S. (1995). Hidden casualties: The relationship between violence and learning. Washington, DC: National Health & Education Consortium. (ERIC Document Reproduction Service No. ED390552)
- Shaughnessy, L., Branum, C., & Everett-Jones, S. (2001). 2001 youth risk behavior survey of high school students attending Bureau funded schools. Washington, DC: Bureau of Indian Affairs Office of Indian Education Programs.
- U.S. Department of Health and Human Services. (1999). 1998-99 trends in Indian health. Washington, DC: Office of Planning, Evaluation, and Legislation, Indian Health Service. Retrieved January 25, 2002, from http://www.ihs.gov/PublicInfo/Publications/trends98/trends98.asp
- U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. (2001). Summary of findings from the 2000 national household survey on drug abuse. Rockville, MD: Author. Retrieved January 15, 2002, from http://www.samhsa.gov/oas/NHSDA/2kNHSDA/2kNHSDA.htm
- U.S. Department of the Interior. Bureau of Indian Affairs, Office of Tribal Services. (1999). Indian labor force report, 1999. Washington, DC: Author.
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