|The International Electronic Journal of Health Education|
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IEJHE, Vol. 3(1), 28-35, January 1, 2000, Copyright © 2000
Mending the Hoop: A Community - University Challenge
Diana Flannery, PhD1;
Mark Franco, Wintu2;
Caleen Sisk-Franco, Wintu3
1 Department of Health and Community Services, California State University, Chico; 2President, Indian Community Outreach, Chico, CA 95929; 3Principle Administrator; Lubeles Academy Charter; Chico, CA 95928
Corresponding author:Diana Flannery, PhD; Department of Health and Community Services, California State University, Chico; Chico, CA 95929-0505; phone: 530.898.4993; fax: 530.898.5107; email: DFLANNERY@CSUCHICO.EDU. Received August 14; revised and accepted October 28, 1999.
The purpose of this paper is to describe a multi-agency, academic approach to American Indian persistence in higher education. By combining the American Indian cultural view, health needs, and the challenges of recruitment and retention of American Indian students, a model for success is presented. By offering the course, Promoting Wellness in the American Indian Community in an off campus, American Indian education center, we were able to establish a familiar safe setting to address the health related issues of AI students enrolled. Affordable college credits were provided as a "step to college" to possibly increase the enrollment of AI's at California State University, Chico (it's least represented population). Finally, the University was presented with the opportunity to enhance its relationship with the AI community, and a method by which to reverse the high dropout rate of AIs on its campus while maintaining high standards of academic excellence. This link between the University and a local American Indian education center is presented as an outreach model for other universities, faculty, and tribal communities.
Key Words: community assessment, Native American, health, community organization
With the exception of some educational institutions located near reservations and the nation's 31 tribally controlled colleges (Matthews, 1999), American Indians are almost invisible on most college campuses. Many researchers believe college campus recruiters do very little to enroll students and even less to retain them (O'Brien, 1991; Tierney, 1992).
Less than 40% of the AI students who graduate from high school enroll in college. Approximately 9% of those students complete four or more years of college compared to 20% of the total population (Bureau of the Census, 1998; Hodgkinson, Hamilton-Outtz & Obarakpor, 1990; Taylor, Denny, Freeman, 1999). The National Advisory Council on Indian Education reported to Congress that the programs and curriculum of non-Indian colleges and universities "...were not attuned to the special cultural needs of the Indian students." High dropout rates are attributed to the difficulty in adjusting to the college environment, cultural conflicts, financial struggles, and the lack of cultural role models. Other identified causes are racism, inadequate academic preparation, and social isolation (O'Brien, 1991).
Many AI students are rich in cultural heritage with unbreakable ties to their family and community. They tend to be quiet, less vocal, and may be unrecognized as Limited English Speakers.
Dr. Rick St. Germaine, associate professor of education at the University of Wisconsin-Eau Claire, says, "Efforts are needed on the campus to ensure a welcoming climate for American Indian
students." (O'Brien, (1991). Women represent a greater percentage of Moreover, almost half of all Indian students attend college on a part time basis (O'Brien, 1991). Research shows that
Women represent a greater percentage ofAI students than their male counterparts: almost six of every ten AI students are women. This creates a pressing need for the campus to address single parenting and childcare issues. There is a need to see these, not as conveniences, but as valid issues of necessity in order for the mother to pursue her educational goal (Evans, 1994). To often the mother's education is sacrificed to care for the needs of their children. If adequate childcare is not available, the mother invariably chooses to drop or stop out. Self-esteem issues for these women must be addressed in order for them to feel welcome and as included in campus life as other students. Also, time management concerns need to be addressed so that mothers can manage their time sufficiently to feel good about being away from their parental responsibility for the length of the school day and the time necessary to prepare for the next days work.
Moreover, almost half of all Indian students attend college on a part time basis (O'Brien, 1991). Research shows thatAIs who succeed in college are those who have a strong sense of cultural identity, have the ability to interact effectively in both Indian and non-Indian communities, and can operate within the complexities of each (Benjamin, Chambers, & Reiterman, 1993; Evans, 1994).
Pavel (1992) asserts that achieving equity in AI participation and graduation from post-secondary institutions depends on maintaining continuity with the K-12 system. Moreover, parental involvement, belief in the relevance of education, relevant curriculum, appropriate teaching styles, promoting community involvement, caring teachers and administrators, and holistic early intervention programs have been identified as contributing to the increase in AI high school graduation rates. Higher education institutions have been challenged to parallel these efforts (Evans, 1994; Pavel, 1992; Reyhner, 1992). This challenge makes it necessary for colleges and universities to set reasonable expectations for providing education to and for the AI student.
The purpose of this paper is to describe a multi-agency, academic approach to AI persistence in higher education. Using an introductory health education course offered in an off-campus American Indian education center, a model for success in AI recruitment and retention is presented. Northern California demographics, previous outreach efforts, and the challenges of providing familiar supportive educational services to AI students are examined.
|Assessment of Needs/Methods|
California State University, Chico (CSUC), a predominantly White, middle class institution serves a vast geographical area covering most of Northern California. The campus is located in Butte County and is in the heart of Indian country. The campus sits on land that is the former site of a Mechoopda Maidu village and is surrounded by the ancestral lands of the Maidu and Wintun people. There are at least four Rancherias (American Indian federal trust lands of 100 acres or less) within two hours of the campus. Within the University's 12 county service area are twenty-one Rancherias and 15,916AIs (1990 Census). The population of Butte County is 202,140 with an AI population of 3,241 or 1.8 % of the county's total. This is the second largest AI population in Northern California. The median age of this population is 24 years.
Further exacerbating the rural conditions of distance and isolation are the economic and cultural corollaries: a declining economic base and comparatively few educational and cultural resources compared to the rest of California. American Indian families in Northern California are one of the lowest socio-economic groups, have the highest school drop out rates, and have the poorest nutritional and health conditions in the state. In California, more than 10 percent of all births are to AI teen mothers. These health concerns are similar to other AIs in poor and rural communities (U.S. Department of Health and Human Services, 1997). The numbers of AIs with diabetes, heart disease, excessive obesity, alcohol, and drug related health problems and accidents leading to death are abnormally high (U.S. Department of Health and Human Services, 1997; Taylor, et. al., 1999). AI youth 14 to 24 years old are among the highest risk groups for fatal accidents, suicide, gang related activity, alcohol and drug related deaths, teen pregnancies, and tobacco abuse (Trujillo, 1996). According to Trujillo (1996), the Director of the Indian Health Service, addressing these compelling health needs requires new strategies, partnerships, resources, and sources for funding.
While California is home to 310,000 AIs, the largest number of Indians in any state, Indian health programs only serve approximately 90,000 (Epstein & Mader, 1996). There is also a great diversity among Indian people even in California and the majority of Northern California Indians are from unrecognized tribes. Behavioral risk trends are difficult to track due to small samples (Taylor, et. al., 1999), and not all AIs use Indian health services or are eligible due to terminated tribal status. Further limiting accurate reporting, AI households without telephones make data collection difficult and many Northern California Indians are still wary of the government due to the forced removal of Indian children to boarding schools.
At present, CSUC has no specific courses to address the health needs of AI students; no retention activities; and no assigned meeting rooms or any staff assigned to work primarily with the AI students. The lack of these vital services leaves the AI students at CSUC vulnerable and at an inequitable disadvantage, especially during their first year on campus. CSUC had an AI recruiter, a financial aid officer, and a clinical psychologist on staff at the time of this study. These individuals, (although not primarily assigned to the service of AI students), provided a valuable link to the Indian community that resulted in higher enrollment and improved retention of that group. However, campus indifference to the needs of the AI student body and the passage of California's Proposition 209, have led to the abandonment of these positions. If recruitment and retention are to be sustained, resources are needed to develop and coordinate academic and social services specifically for AI students. Many AI students are unaware of or do not know how to access the student services available for the general student population. In the absence of specific AI services over 70% of AI students at CSUC flounder and exit via a revolving door or drop out by their second semester.
The CSUC has an extremely long, non-productive history relative to the recruitment of AI students and faculty, admission, retention and graduation of the AI population. In retrospect, the
California Indian people are truly the invisible and largely forgotten segment of California's educable population. For example, in the 100 plus year history of CSUC, The sweat leader and doorman guide each round and tend to the needs of each participant. An exchange of trust and the ability to focus on the task at hand provides one with self-worth,
value to the community, and the desire to accomplish the goal.
The sweat leader and doorman guide each round and tend to the needs of each participant. An exchange of trust and the ability to focus on the task at hand provides one with self-worth, value to the community, and the desire to accomplish the goal.
While Butte County, California holds the second largest AI population in the North State, the formal educational system has made insignificant and sporadic progress in meeting the educational needs of the county's AI people. As members of a concerned group of faculty and staff, we struggle to find creative ways to serve AI students within the constraints of the CSU system or even have the system acknowledge this population.
Those in health education are trained to assess the needs of individuals and communities as a foundational responsibility of health educators. Traditional assessment typically focuses on problems, needs, barriers, and weaknesses and rarely on the strengths or assets of communities. According to Parks and Straker (1996), much of what we know about health education programming is based on communities' problems and little about its possibilities. This outreach program helped AI students, outside the university walls, gain access and also served as an entry point which allowed students to feel safe, accepted, and experience learning on their own terms. After months of planning and finding ways to speed the admissions process through special admit status, we finally gained adequate support to develop and conduct an off-campus course 'Promoting Wellness in the American Indian Community.' This outreach model is built on values and traditions of this AI community and established community programs. This link between the AI community and University allowed traditional principles and foundations to be put into the classroom environment before the introduction of the rigors of academic study.
By building a university based health education program in the AI community, students were recruited and retained by the University.
This off-campus location became the sweatlodge and provided the sweat leader, door man, and fire tenders for its AI students. For the first time, capitalizing on AI community assets, the following goals were set:
To enhance the health and academic preparation of
2) To recruit and retain AIs into CSUC by finding creative ways to enroll community members into higher education;
3) To provide an opportunity for University staff and faculty to participate in an innovative community outreach program;
4) To help prepare students planning to work in AIcommunities by creating links with AI agencies.
This off-campus location became the sweatlodge and provided the sweat leader, door man, and fire tenders for its AI students.
For the first time, capitalizing on AI community assets, the following goals were set:
1) To enhance the health and academic preparation ofAIs in the region;
Promoting Wellness in the American Indian Community
During the 1996 spring semester, a 3-unit, CSUC course was held for the first time at the Four Winds of Indian Education Center (Four Winds). Four Winds founded in 1989 and located in Chico, California, is a non-profit, incorporated, Indian education organization. The goal of Four Winds at the time of this study was to improve the academic achievement of Indian youth (preschool to grades K-12) as well as adult education. Additionally they strove to strengthen the bonds of the Indian community by providing an active participation program that embraced the whole family.
Promoting Wellness was selected as the first course offering because the professor who initiated the course had an expertise in AI health issues and she was in the Department of Health and Community Services at CSUC. The course was also selected and revised based on the interest and need for the course in the AI community and it fulfilled a general education requirement for lifelong learning. Through additional lobbying, the adapted curriculum fulfilled an elective for the AI Studies minor thus benefiting the AI college student as well.
The sweat leader begins to prepare the lodge long before the door opens to welcome those who come.
The curriculum for the course followed typical wellness topics such as mental health, self-esteem, drug misuse/abuse, chronic and communicable diseases, and sexual health. With some research and background in AI health, each lesson easily lent itself to integrating contemporary AI health issues. This approach was based on earlier work by Navarro, Wilson, Berger, and Taylor (1997) which emphasized traditional values and the role of history and spirituality as they related to the health of Native peoples. For example, the conflict between ceremonial and chronic uses of tobacco, the myths surrounding alcohol among AIs, the impact of reservation life and commodities on diet and diabetes, and the legacy of boarding schools on the breakdown of AI families and traditions were discussed. American Indian specific morbidity and mortality factors relating to each topic were included as well as AI views of wellness. Projects for the course included behavior change journals, alcohol critiques, reflective papers, and creating traditional prevention messages targeting AIs. These prevention messages were displayed at Four Winds. Students sat in small groups and the instructors of the course followed a lecture/discussion format. Three surveys were administered during the semester to determine chronic and ceremonial tobacco use, sexual health risk, and college curriculum interests/needs. The course was led by a non-Indian professor (who developed professional ties and sincere trust of the AI community) and a local Maidu Indian (an advisor from the campus office Talent Search for Education) served as classroom facilitator.In addition to enhancing cultural identification by inviting traditional healers and spiritual leaders as guest presenters, AI community leaders currently working in the health professions (Indian Health Service, California Rural Indian Health Board, etc.) were also invited to discuss real issues facing Northern California Indians. Mayfield Publishing generously donated 50 wellness texts and study guides for this college course to maintain a standard college experience. Limited funds were also made available through Project FLINT (a family literacy program) and a CSUC faculty development grant for transportation, childcare and course development.
The Sweat Lodge Model
The framework for this outreach effort comes from an adaptation of the way the Wintu co-authors run their family sweat lodge. First you must identify who is the sweat leader, fire tender and doorman to run the sweat. Basically there are four rounds each focusing on a specific purpose. In this sweat lodge model it is important to view the educational process and needs as parts of a circle or cycle.
The first part of that cycle is the caring for one's basic needs (e.g. Maslow). In order to learn and become a part of a larger system and what that system requires one must first have a safe place of belonging to learn. Secondly, needs that can be met immediately and those areas that may need improvement must be established. This first round establishes a safe environment in which participants feel free to speak up or participate. The safe educational environment of this course included a learning to mastery approach, combining Indian students (grouping) in the same classes and providing assistance as needed. In the sweat, in this first round one prays for oneself. This is based on the belief that if you are not well and able to help yourself "in balance" you will not able to help someone else. Therefore, if a place of belonging is provided for AIs to learn the "system" and that place is respected as valid by the university community, retention and persistence rates will undoubtedly rise.
The second phase of the program follows the cycle to extend out to those family and friends closest to the student in their support system. As AI students become more comfortable within the university setting and comfortable with the idea that they can survive in what, for many, seems a racist, hostile environment, additional classes outside the group can be set. This becomes a viable option and a desired outcome. What occurs, in effect, is an expansion and diversification of the "Indian only" foundation by which they entered the university. The second phase is further designed to prepare the student for success in the university environment. The students become better equipped to thrive; they become a part of the larger university environment and hopefully participate in a larger, diverse society. In this way, as in the sweat lodge, the students are able to take care of their own needs and then the needs of others. This methodology does not simply "cut the student loose to sink or swim," but rather provides for a safe haven of entry and an area where they know that they can find refuge.
The third phase then is the development of an understanding of the student's place in the larger society. During this stage, the students are provided the opportunity to develop the skills necessary to be responsible for their own education and their acclimation (not acculturation) to the university setting. The students are then ready to begin working within the greater Indian community. The focus of this stage is in relation to the successful interaction with people of the Indian community and AI institutions. In this way, like in the third round of the sweat lodge, we pray for the others who support us, the different nations: animal, four legged, winged, the swimmers and crawlers, all of the other groups who live with us. Again, this is tied to the idea that we cannot care for others until we can care for ourselves. Many university programs push students into community service without having the student capable of handling the responsibility that comes with the assignment. Through this method, the students are brought along gradually, introduced to the needs of the AI community, and placed so that their particular strengths and skills are highlighted.
The fourth stage is the closing round, the round in which we give thanks. The participant recognizes and benefits from their ability to stay all four rounds with those who entered the lodge with them. Now they will exit together knowing they are stronger and have the inner strength to make beneficial changes within themselves and their communities. Here in the sweat lodge model, the student graduates from the program. At this time, the community then comes forward and bestows back to the student what the student bestowed on the community.
A World of Diversity
After months of meeting recruitment and admission's standards, 48 AI students attended the first night class. The class was scheduled to meet once per week in the evenings. There was tremendous group diversity within in the class. Participants ranged in ages 17-52 with a mean age of 26 years. Two-thirds of the class had children with a mean of 2.25 children and 70 percent of the class was female. Over twenty different tribal groups were represented (Apache, Blackfoot, Cherokee, Choctaw, Chippewa, Chumash, Comanche, Hupa, Karuk, Klamath, Maidu, Mechoopda, Miwok, Navajo, Nez Perce, Nomalaki, Paiute, Pit River, Pomo, Wintu, and Wintun). Interestingly, there was an absentee rate of only 1.35 per student. Thirty-one students completed class (65% completion) and 27 earned college credit. Many different factors contributed to attrition. Three women dropped due to pregnancy and one to miscarriage. Other conditions included fines owed to CSUC, unit deficiencies, no support or transportation, uncomfortable discussing sexuality issues, and family crises. Even so, the AI class completion rate is outstanding for a college class in the CSU system.
A 25-item tobacco use questionnaire and 32-item sexual risk questionnaire were administered to 32 students after approval from the Human Subjects committee and the results were discussed in class. General findings of the studies revealed:
This group is at risk for tobacco and sexuality related problems. Several of the students were uncomfortable discussing the sexual behavior survey results but by using these findings, high-risk behaviors were made personal, relevant, and brought into the open. Concerning the issue of sexuality, AI people do not typically speak of sexual based issues in front of the opposite sex and rarely openly to same sex individuals outside of a particular family or clan. Yet in this particular class, a number of students did report they were sexually active and were given accurate information to maintain their sexual health.
Varieties of age groups as well as academic levels were represented. Four high school students, nine university students, ten community college students, four adult literacy/GED students and four "stopped out" students enrolled through Continuing Education.
Another fascinating layer of the class dynamics was the inter-relationships of the class members, which included grandparents, aunts, brothers, sisters, marriage partners, cousins, in-laws, mothers/sons-daughters, and nursing mothers. There were 11 new mothers or pregnant woman in the class.
We attempted to find an innovative way to recruit AI GED and high school seniors into CSUC, retain AI students already enrolled, and re-enroll AI students into CSUC. One part of this recruitment effort was supported by the Step to College program. This important program removes a financial barrier by providing 3-6 college credits for $7.00 for students currently in high school or completing a GED. The Step to College program was designed for under represented ethnic high school students to be enrolled in a college course. We enrolled approximately 8 AI students who were either high school students or pursuing their GEDs. Many of the Step to College students do eventually attend CSUC.
Butte County and surrounding counties have a sizable AI population and promotion of this program allowed us to outreach to this untapped population as well as begin mending the hoop between our university and the community. While our AI students were highly motivated to attend other courses at Four Winds, we were unable to find university support to offer other courses at the time. However, the local community college has since offered numerous courses at the Four Winds site.
|Building a Bridge|
Six agencies were involved with administering this project. They included the university offices of Talent Search for Education, Outreach, and the Department of Health and Community Services, Four Winds of Indian Education, Project FLINT (Title IX Indian Education program) and Butte Community College. We were all personally and professionally committed to finding ways for building stronger connections between CSUC with the AI community.
We assessed the success of this program through student retention, course completion, course projects, new enrollments, and improved health of the students. The most notable features of the program were:
Comments offered by the students reflected the goals we had for the program. One woman addressed the importance of learning on American Indian terms:
I never felt so comfortable in a classroom as I did in this class. Having the class held at Four Winds made it feel like home, and since it was all Indians, it felt like I was taking a class with my family. My friends were there and I would find myself not wanting to miss class since it gave me a chance to see everyone.
Another young woman reflected on the relevance of the course material to her life:
The course has been a tremendous help on my life. Over the past semester I have been overwhelmed with stress and depression. The material from the class was also very beneficial and could be applied right away to my life.
Another student commented on the significance of relating to health from a contemporary AI perspective:
I really learned from the class because it was put into a Native American perspective. I liked looking at better eating habits from this perspective since most Indians like fry bread and Pepsi. It was more comfortable looking at my bad eating habits with everyone else because we all seemed to have the same bad habits, except for the nutrition major Jesse.
Students were able to apply classroom knowledge to their own behavior and many students were challenged by the behavior change project. Jason commented:
This class helped me look at my own health behaviors more openly. I realized I had a problem with smoking and quit. Before smoking was a way of life for me. Some days I do have thoughts of having a cigarette, but my willingness to abstain is due to my traditional outlook on the use of tobacco for sacred purposes only. Due to this, I feel better mentally and enjoy feeling healthy. In place of smoking, I do my smudges and prayers everyday. On weekends, I participate in sweat lodge ceremonies.
Louise commented on the importance of Four Winds as a safe place to discuss personal health topics:
Since it were all Indians I felt comfortable talking about some of the issues presented such as sex, unhealthy relationships etc. I felt comfortable talking to people next to me since they were also Indian and could relate to the problems that Indians have on the reservation, off the reservation, and in school. I didn't feel like I was being judged because I had a dysfunctional family since most everyone else did too. I didn't feel like my family was being stereotyped as "savage Indians" just because we had problems.
Now they will exit the lodge together knowing they are stronger and have the inner strength to make beneficial changes within themselves and their communities. Thus, the sweat lodge closes and preparations are made within the circle for another day..
Rochanne also felt having a class at Four Winds contributed to her social support:
Probably the best thing was just being able to discuss issues in a comfortable setting. I also felt like I became closer to some of the Indians in my class. Since we were sitting next to each other and talking about personal issues I felt like I have created a strong support system with people who better understood my situations. Talking about health and fitness were good. After class a bunch of us would go play basketball.
Recruitment and retention of AI students was a goal for this course. Paul, a re-entry student now sees himself as part of the educational system and bestowed thanks as in the fourth round of the sweat:
This class has given me the opportunity to move back into education in a way that is positive. I am now setting new goals that were unthinkable before. I look forward to many more healthy and safe years of living with the knowledge and insight I have gained through the course. I thank you for allowing me this opportunity to express my gratitude and respect for you.
By offering the Promoting Wellness course, we began to address the health of the AI students enrolled. Affordable college credits were provided as a step to college. Weekly tutoring sessions provided at both Four Winds and Berry Creek Rancheria were initiated. CSUC worked toward developing a better reputation with the AI community. Enrollment of AIs (the least represented population), increased at CSUC during this semester. An attempt was made to reverse the high dropout rate of AIs on the CSUC campus while maintaining standards of excellence. This link between the University and Four Winds serves as a model for other universities to adopt for increasing their visibility within other AI communities and local Indian education centers.
The mission of the many universities as well as CSUC is to attract students from underrepresented groups and to be involved in regional projects as well as collaborating with K-14 students and educators. Also developing culturally diverse teaching examples enhance the University's commitment to cultural diversity. This outreach example addresses all of these goals.
American Indian communities must band together, identify universities willing to provide an education, understand the rights given to Indian people, and make universities cognizant of barriers facing Indian people. Instead of defining the problems in terms of low achievement, high attrition, poor retention, and weak persistence, thus placing the need for adjustment on the students, the institutions themselves must be held accountable. Kirkness and Barnhardt (1991) challenge the higher educational system to respect AI students for who they are, that is relevant to their world view, that offers reciprocity in their relationships with others, and that helps them exercise responsibility over their own lives. Health education is a good place to start.
Benjamin, D.P., Chambers, S. & Reiterman, G. (1993). A focus on American Indian college persistence. Journal of American Indian Education, 24-40.
Epstein, M.E., Mader, S. (1996). Tobacco, alcohol, and other drugs used during pregnancy among American Indians in California, 1995. A Report of the California Area Indian Health Service.
Hodgkinson, H. L., Hamilton-Outtz, & Obarakpor, A.M. (1990). The Demographics of American Indians: One percent of the People; Fifty Percent of the Diversity. Washington, DC: Institute for Educational Leadership, Inc.
Kirkness, V.J. & Barnhardt, R. (1991). First Nations and higher education: The four R's- respect, relevance, reciprocity, responsibility. Journal of American Indian Education, 30(3), 1-15.
Matthews, K. (1999, April 5). Tribal college enrollment up 62 percent. Community College Week, 11(18), 3.
Mihesuah, D.A. (Winter,1996). Voices, interpretations, and the 'new Indian history.' American Indian Quarterly, 20(1), 91-108.
Navarro, J., Wilson, S., Berger, L.R., and Taylor, T. (1997). Substance abuse and spirituality: A program for Native American students. American Journal of Health Behavior, 21(1): 3-11.
O'Brien, E.M. (1991, Mar 29). The demise of Native American education. Part II. A foot in each world: American Indians striving to succeed in higher education. Black Issues in Higher Education: 27-31.
Parks C.P., Straker H.O. (1996). Community assets mapping: Community health assessment with a different twist. Journal of Health Education, 27(5):321-323.
Pavel, D.M. (1992). American Indians and Alaska Natives in higher education: Research on participation and graduation. ERIC Digest (ED 348187). ERIC Clearinghouse on Rural Education and Small Schools, Charleston, WV.
Reyhner, J. (1992). Teaching American Indian Students. University of Oklahoma Press: Norman and London.
Taylor, T.L., Denny, C.H., & Freeman, W.L. (1999). American Indian and Alaska Native trends in behavioral health. American Journal of Health Behavior, 23(5), 345-351.
Tierney, W.G. (1992). Official Encouragement, Institutional Discouragement: Minorities in Academe-The Native American Experience. Norwood, NJ: Ablex Publishing Co.
Trujillo, M.H. (1996). Message from the director: Looking to the future of the Indian Health Service. The IHS Primary Care Provider, 21(12), 157-165.
U.S. Department of Health and Human Services. (1997). Regional differences in Indian health. Public Health Service. Indian Health Service: Rockville, MD.
[Reprint (PDF) Official Layout of this article]
Copyright © 2000 by IEJHE.
Copyright © 2000 by IEJHE.