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  • Embracing Community and Culture to Prevent Underage Drinking

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    For Native American Heritage Month, learn how understanding culture helps prevent alcohol misuse among American Indian/Alaska Native youth.

    By George F. Koob, Ph.D.
    Director, National Institute on Alcohol Abuse and Alcoholism

    Supporting research to better understand and address alcohol-related health disparities and improve the health of underserved populations is one of the highest priorities of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

    Among our efforts is NIAAA’s long-term investment in preventing underage drinking. Early initiation of alcohol consumption and heavy drinking increases the risk of alcohol use disorder (AUD) and related consequences over a person’s lifetime, and alcohol intervention efforts started at a young age can positively influence a young person’s path in life. Research indicates that prevention efforts involving the community and/or informed by the community’s cultural beliefs hold promise for preventing and reducing underage drinking.

    In a decades-long project supported by NIAAA, Stacy Rasmus, Ph.D., at the University of Alaska, Fairbanks, in collaboration with the Yup’ik Native Alaskan community, is examining how tapping into a community’s culture can provide a cornerstone for youth substance misuse and suicide prevention efforts. Together, they developed the Qungasvik (Tools for Life)” Toolbox” intervention, which uses community, cultural, and historical connectedness to build protective factors against suicide and alcohol misuse at individual, family, and community levels. Research findings have shown that Qungasvik is effective in reducing co-occurring youth alcohol misuse and suicide risk, and ultimately, AUD and death by suicide.

    Other NIAAA-supported studies have demonstrated the importance of community mobilization in preventing underage drinking among American Indian/Alaska Native (AI/AN) youth. Kelli Komro, Ph.D., at Emory University, and colleagues worked with the Cherokee Nation to implement and test the effectiveness of Communities Mobilizing for Change on Alcohol, a community-organizing intervention designed to reduce youth alcohol access. The community-level intervention was implemented and evaluated alongside CONNECT, a school-based alcohol screening and brief intervention. The researchers found that the prevention strategies either alone or in combination were effective in reducing alcohol use among American Indian (AI) and other youth living in rural communities.

    In another study, Roland Moore, Ph.D., at the Pacific Institute for Research and Evaluation, and colleagues evaluated a combined community- and individual-level intervention on underage drinking among AI youth living on rural California reservations. The community interventions included restricting alcohol sales to minors as well as activities to raise awareness of the risks of underage drinking and to mobilize community support for the interventions. The individual interventions consisted of either culturally tailored brief motivational interviewing or education about the consequences of drinking and dangers of binge drinking, assisted by a therapist. Among youth who drink, researchers found reductions in the frequency of drinking and heavy drinking among AI youth exposed to the interventions relative to non-AI/AN students from their region and rural AI/AN students outside of the intervention area.

    Pictured are two youths who are members of the Yup’ik community in Alaska, which is collaborating with an NIAAA grantee on an alcohol-use prevention program. Photo Credit: Georgianna Ningeulook, Scammon Bay, Alaska

    These studies demonstrate that community-based interventions, alone or in combination with individual-level interventions, can play an important role in preventing underage drinking among AI/AN youth. It is essential that that we continue to develop, implement, and sustain culturally informed, effective, evidence-based interventions to prevent alcohol and other substance misuse, as well as the many related consequences from suicide to AUD, among underserved youth across the nation.


    1. Rasmus SM, Trickett E, Charles B, John S, Allen J. The qasgiq model as an indigenous intervention: Using the cultural logic of contexts to build protective factors for Alaska Native suicide and alcohol misuse prevention. Cultur Divers Ethnic Minor Psychol. 2019 Jan;25(1):44-54. doi: 10.1037/cdp0000243.
    2. National Institute on Alcohol Abuse and Alcoholism. NIAAA to Host Webinar on Interventions in American Indian and Alaska Native Communities. In: NIAAA Spectrum Vol. 12, Issue 3, Fall 2020 Accessed May 2021.
    3. Komro KA, Livingston MD, Wagenaar AC, Kominsky TK, Pettigrew DW, Garrett BA; Cherokee Nation Prevention Trial Team. Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health. 2017 Mar;107(3):453-459. doi: 10.2105/AJPH.2016.303603. Epub 2017 Jan 19.
    4. Moore RS, Gilder DA, Grube JW, Lee JP, Geisler JA, Friese B, Calac DJ, Finan LJ, Ehlers CL. Prevention of Underage Drinking on California Indian Reservations Using Individual- and Community-Level Approaches. Am J Public Health. 2018 Aug;108(8):1035-1041. Epub 2018 Jun 21.
    5. National Institute on Alcohol Abuse and Alcoholism Strategic Plan 2017-2021. Accessed May 2021.
  • National Minority Mental Health Month: Reflections and Resources

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    July is National Minority Mental Health Month and NIMHD is sharing reflections and resources for mental and emotional well-being of racial and ethnic minority communities.

    Mental illness does not discriminate, and more than 40 million Americans experience them each year regardless of race, ethnicity, gender identity, or socioeconomic status. July is National Minority Mental Health Month—a time to raise awareness about the unique psychological struggles that people from racial and ethnic minority communities face.

    For National Minority Mental Health Month, NIMHD is sharing reflections and resources about the challenges, stigma, and access to mental health providers minorities often experience. We encourage you to educate yourself, your families, and your communities about mental health and emotional wellbeing.

    Reflections: Prior NIMHD Insights Blog Posts


  • Don’t Forget the Good: Reflections from LGBTQ+ Youth Before and During COVID-19

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    By Jeremy T. Goldbach, Ph.D., LMSW
    Associate Professor
    Chair, USC Social Behavioral Institutional Review Board
    Director, Center for LGBT Health Equity
    Pronouns: He/Him
    University of Southern California
    Suzanne Dworak-Peck School of Social Work

    I remember it like yesterday. I stepped into the small, cramped meeting room of a local LGBTQ drop-in center. The room served triple duty as a social milieu, computer lab, and meeting room. Posters and homemade art covered the walls, displayed proudly everywhere the eye could see like wallpaper, almost demanding inspiration and hope from passive onlookers. The warm room, paired with the anxiety that no title or position can ever seem to overcome, made my hands clammy. I had arrived seeking feedback on an intervention we had been developing for nearly a decade. Bracing myself for the brutal honesty only found in adolescence, I opened the floor. “So, what do you think?”

    Silence. I thought back to my lessons on pedagogy—it takes people an average of seven seconds to respond to a question, Jeremy. Relax. One … Two … Three. More silence. I could feel my carpe diem moment slipping away, so I looked awkwardly to the posters for solace and inspiration.

    “Well—.” Someone finally spoke. Relief. “We talked a bit before this meeting, and we are trying to understand. Why do you only seem to want to talk about the bad things that happen to us, when there is so much good, too? We come to this center to be affirmed. I mean, look around—it’s literally all over the walls.” They pointed to the posters I had sought refuge in earlier, which now seemed to mock me.

    I didn’t know how to answer. I had spent my entire career to this point so focused on the disparities that LGBTQ+ youth experience, it was difficult to even begin to consider the good things in their lives. Indeed, my own work (and that of many others) has found copious evidence of the stigmatizing, discriminatory, and violent experiences these youth encounter every day and the resulting impact on their health. Like many others, I have drawn on my own experiences growing up a gay kid who was told that being gay meant never being happy and probably dying a lonely death (a narrative I still write at times).

    But they were right. Despite all the negative and heartbreaking things we have been programmed to study in this deficit-based world, there are good people out there: parents, teachers, mentors, and even school systems trying to make a difference and pass good policies to protect LGBTQ+ youth and enhance their health and well-being. The problem is, we’ve spent so much time trying to understand the things that do damage, we still know almost nothing about the programs, practices, and policies that promote resilience and safety.

    Our research on the effects of the COVID-19-related quarantine show this, too. Although many young people in our studies did report difficulty in family relationships and isolation from supportive peers, this wasn’t always the case. Many described being home as a reprieve from their challenging experiences at school, where the safety of their family (and ready access to a private restroom) ensured they could avoid navigating a highly stressful learning environment. As one youth told us recently, “Me and my family…have been taking walks every other day or so. I think I’ve actually gotten closer to my parents from this.” Similarly, in meetings with local schools, one superintendent said, “We want to support our students, but someone has to tell us how!”

    So, the question remains: how do we learn from these unprecedented times, not only to confirm what is wrong in the world, but also to explore what is right? For my sake, at least, I’m trying to regularly remind myself that although it is true that LGBTQ+ youth need support when they experience stigma, violence, and victimization, life is not all bad. Youth live in a dynamic world now, where stress and resilience commingle to create the fabric of their lives. And to support them in their journey, we need to understand all facets of their experience—certainly the painful and difficult ordeals, but also the life-affirming, wholesome, and supportive moments that bring them joy and hope.

  • Other Impacts of COVID-19: Anti-Asian Hate

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    By Gilbert C. Gee, Ph.D.
    Professor, Department of Community Health Sciences

    UCLA Fielding School of Public Health
    University of California, Los Angeles

    The rise of COVID-19 coincided with a rise in reports about anti-Asian hate incidents in the U.S. and around the world in 2020. Analyses of social media data showed a massive 17,000% increase in negative sentiment against Asians that correlated with our former president’s infamous use of the phrase “China virus” in March of 2020, which directly contradicted calls by public health officials to use neutral terms such as “COVID-19.” 1 Other research confirms these trends2.

    In response to the rising hate incidents, community groups created new reporting systems, such as, which sought to document hate incidents. New voices emerged from academics, politicians, actors/actresses and others who have condemned these incidents. And refreshingly, the news media have begun to write about anti-Asian hate incidents — in years past, such reports were far more likely to remain invisible.

    Yet, here we are a year later, facing the same issues.

    What this demonstrates is that we have poor infrastructure for capturing oppression. The formal channels for documenting hate incidents were viewed as inadequate. Members of the community felt that anti-Asian incidents were not taken seriously by authorities, a problem that was compounded by language barriers. Accordingly, the Asian American community had to create new ways to document hate incidents themselves. Much has been done over this past year.

    And yet, we run the risk of making a few mistakes:

    The first mistake is equating hate crimes with the face of racism. Certainly, hate crimes are life changing. A single assault is one too many. Even minor slights can affect both physical and mental health.3 Yet, their presence should not be the only reason, or the only time, we think about racism. We often assume that all is well if there are no reports of hate crime victims, such as Vincent Chin, Breonna Taylor, George Floyd, or Vicha Ratanapakdee. That assumption is a deadly mistake.

    The second mistake is assuming that a single politician, social group, or entity is the cause of racial problems. But that view is too simplistic. It lets the rest of society—including ourselves—off the hook. Structural racism is not about racist individuals or groups. It is about how the entire organization of society is built to enshrine white supremacy. So, yes, we should hold people and groups accountable for their actions, but we should not stop there. We should view all of the machinery of society, including our laws, policies, and informal actions as having inequality built into its equilibrium.4 Unraveling racism means attending to all these interconnected systems. We should not simply focus on perpetrators of hate crimes who are enabled by the system to be seen as bad apples having bad days. We need to acknowledge that the rot is systemic. And, we need to encourage the brightest thinkers to find new solutions.

    The third mistake is holding our tongues because so many times in the past, our voices were ignored or invalidated. These invalidations often arise due to Asians erroneously being perceived as a model minority (being economically successful and healthy, which is not true).5 Sometimes, these perceptions become internalized. I have heard many fellow Asian Americans say, “I don’t have a right to talk about racism against me; others have it worse.” Such guilt is the work of structural racism, which encourages complicity with the status quo. That is, silence signals consent to oppression. Let us not make these mistakes. Let us own our experiences that are earned, just, and deserved. And more importantly, let us raise our voices to express outrage, in high resonance to shatter the structure of inequality.

    Asian American and Pacific Islander (AAPI) Heritage Month is not only about celebrating our heritage. It is about honoring every one of us who had to endure the “where are you from” question, or the “you don’t act like other Asians.” It is also about recognizing those who were deported, falsely accused, or murdered. And it about those whose own modest lives tipped the scales a fraction towards equality, including Wong Kim Ark, Kinney Kimmon Lau, Grace Lee Boggs, and Yuri Kochiyama, who, if you don’t know, you should look up.

    Finally, it is a living history that will be written by our children, who we hope will inherit a healthier, civil, and just society.


    1. Hswen, Y., et al. (2021) Association of “#covid19” Versus “#chinesevirus” With Anti-Asian Sentiments on Twitter: March 9–23, 2020. American Journal of Public Health, 0, e1-9.
    2. Thu, N.GT., et al (2020) Exploring U.S. Shifts in Anti-Asian Sentiment with the Emergence of COVID-19. International Journal of Environmental Research and Public Health.
    3. Cheah, C.S.L., et al. (2020) COVID-19 Racism and Mental Health in Chinese American Families. Pediatrics. 2020 Nov;146(5):e2020021816.
    4. Gee, G.C., Hicken M., (in press). Structural Racism: The Rules and Relations of Inequity. Ethnicity and Disease.
    5. Wing, J. Y., (2007). Beyond Black and White: The Model Minority Myth and the Invisibility of Asian American Students. The Urban Review, Vol. 39, No. 4.
  • A Black Doctor and Scientist on Vaccinating Minorities

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    NOTE: For National Minority Health Month, NIMHD Insights Blog is sharing this timely op-ed that was printed with permission from the Houston Chronicle from former and founding Director of NIH’s National Institute of Biomedical Imaging and Bioengineering, Dr. Roderic I. Pettigrew.

    By Roderic I. Pettigrew, Ph.D., M.D.
    CEO of Engineering Health

    Executive Dean of Engineering Medicine
    Texas A&M University and Houston Methodist Hospital
    Former and Founding Director, National Institute of Biomedical Imaging and Bioengineering

    When it was first announced that a COVID-19 vaccine was authorized for emergency use by the Federal Drug Administration in the United States, the scientific community was finally able to exhale. As a Black physician and member of the scientific community, I was particularly encouraged because of the disproportionately higher rates of hospitalizations and deaths from COVID-19 among the Hispanic, Black, and Indigenous American populations.

    My relief, however, was short-lived. We continue to see troubling inequities with new reports showing that many people from the minority community are among the lowest currently receiving the new vaccines, and the highest to be hesitant about its safety and effectiveness. According to Pew Research Center1, just 42 percent of Black adults are inclined to get vaccinated, compared to 63 percent of white adults and 83 percent of adult Asian Americans.

    The hesitation to get vaccinated is certainly understandable. Minorities have for centuries experienced egregious experimentation without consent.2 From J. Marion Sims, who used enslaved Black women as test subjects, to the federally sponsored and secretive Tuskegee study where treatment for syphilis was intentionally withheld, and the more recent unconsented use of tissue and cells taken from Henrietta Lacks while a cancer patient, Black America’s relationship to science and research has been in multiple instances exploitative and inhumane.

    But this vaccine is not another Tuskegee. Looking at the preliminary data on who is getting vaccinated tells us that. News reports3 to date indicate that those who are majority persons and wealthy, including some from outside of the U.S., are quite active in pursuing vaccinations in America. National results show that Black people were inoculated at levels far below their share of the population. At the end of January, composite data4 shows that less than 5 percent of the vaccinations had been administered to Black people.

    There is no doubt that the lack of equity in access is also playing a role in such low vaccination numbers. Currently, Black residents are significantly more likely than whites to live more than a mile from the closest vaccination facility5. Online portals and phone applications have been popular tools deployed across states to schedule vaccinations. But this leaves those who fall into “digital divides” and “app gaps” behind.

    However, these challenges should not be compounded with fear. Some say that they want to wait and see if anything adverse happens to others who were vaccinated. This is a reasonable initial thought, but it should be weighed against the science, the demonstrated use and the clear risks. The science, conducted in tens of thousands of people of multiple ethnicities in multiple countries, shows a strong safety profile. Moreover, unlike the Tuskegee experiments, those advocating, conducting, and overseeing the vaccination studies are among the first in line to take the COVID-19 vaccine themselves. In Tuskegee, known curative treatment was withheld from Black patients. Now the effort is to deliver preventative vaccines. White Americans are getting these at disproportionate rates while underrepresented people are disproportionately bearing the brunt of the COVID-19 illnesses.

    I chose to get the vaccine because I know and trust this science. At the same time, I recognize the logical concerns about the safety of the vaccine in a process that was indeed accelerated. While this vaccine was created unusually fast, the speed is the result of technological innovations that have actually been in development for two decades, supported by the National Institutes of Health and the Defense Advanced Research Projects Agency. In addition, there has been new federal economic support for more COVID-19 focused development and manufacturing processes in parallel. Now, as the country passes more than half a million dead, we have a means to stop this death toll.

    Indeed, people of color have the most to lose in the fight against this virus, and therefore, the most to gain by getting vaccinated. Now we can take advantage of the very best that modern medical science has to offer. The weight of the evidence is overwhelmingly clear for all people. Everyone eligible should get the vaccine when it is available for you to do so.

    To improve equity in access to the vaccine, leaders in government and all sectors of industry must work to reach our most vulnerable groups where they are located. This is working now in the extremes of Alaska, which leads the nation in vaccination rates6 despite much of the Native population being in remote and isolated communities. For underserved populations nationally, this means direct communication, not phone apps. It means purposeful targeting and collaborations with community churches, barber shops, Federally Qualified Health Centers, and community health centers. It means vaccination hubs and providers placed in the underserved areas of Houston. It means equipping the most trusted figures in minority communities with the best information to counter the myths. And it means closely monitoring vaccination assignment and delivery to ensure equitable inclusion. For minorities, this is indeed urgent.


    1. Funk, C., Tyson, A. (2020). Intent to Get a COVID-19 Vaccine Rises to 60% as Confidence in Research and Development Process Increases. Pew Research Center Science and Society. Retrieved from
    2. Simmons, M., Gaston, D. (2021). Why so many Black patients’ distrust Covid-19 vaccines (and 3 ways to rebuild their trust). Advisory Board. Retrieved from
    3. Siemaszko, C. (2021). Vaccine tourism on the rise as wealthy international tourists eye an opportunity in the U.S.(2021, January 25) Retrieved from
    4. Painter E., et al., Painter E., et al. Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program – United States, December 14, 2020-January 14, 2021. Morb Mortal Wkly Rep. 2021 Feb 5.
    5. Where Black Americans Will Travel Father Than Whites for COVID-19 Vaccination. (2021, February 4) Retrieved from
    6. The Rural Alaskan Towns Leading the Country in Vaccine Distribution. (2021, February 21). Retrieved from