Change in Health Status Among American Indian/Alaska Native Adolescents Living Outside of Tribal Land in California Before and During the COVID-19 Pandemic.

PURPOSE: This article describes change in health status by analyzing key health domains at two time points before and during the COVID-19 pandemic among a sample of American Indian/Alaska Native (AI/AN) adolescents living outside of tribal land (n = 114) throughout California.

METHODS: Data were analyzed from a longitudinal study, Native American Youth Sleep Health and Wellness (NAYSHAW). To test changes in health from baseline (March 2018-March 2020) to follow-up (December 2020-June 2022), we ran a series of linear regression models for continuous measures and repeated measures logistic regression models for dichotomous measures for physical health, behavioral health, and cultural contexts of health and well-being.

RESULTS: For physical health, body mass index percentile significantly decreased (p = 0.02), and both systolic and diastolic blood pressure significantly increased (p < 0.001 for both), although both measures remained within the normal range for adolescents. For behavioral health, depression and anxiety significantly increased (p = 0.005 and 0.008, respectively), although they remained within subclinical levels, and no significant changes were observed with alcohol and cannabis use. For cultural contexts of health and well-being, both cultural identity and sense of historical loss significantly increased (p < 0.001 and p = 0.03, respectively).

DISCUSSION: We observed a mix of positive and negative health changes among AI/AN adolescents living outside of tribal land before and during COVID-19. Findings highlight that enhanced cultural identity during adolescence may have helped foster resilience during this difficult period.