Matt is 18-years old and recently moved from the Tohono O’odham Nation Reservation, Papago, Arizona where he was born and lived his entire life.

He now lives with his aunt in Phoenix, Arizona, approximately ten hours north of the reservation.  Two important events in Matt’s life have recently occurred – graduation from high school, and his mother re-married.  Matt doesn’t approve of his new stepfather who is non-Native, and his stepfather doesn’t approve of Matt and his plan to pursue a career as a men’s fancy dancer – a fast, elaborately choregraphed Native American pow-wow dance.

Matt also does not approve of the disrespectful way his new stepfather addresses he and his mother. So, he decided to move away from the reservation and live with his aunt in Phoenix. Matt didn’t know his biological father and he and his aunt became very close when she lived with their family on the reservation. He’s looking forward to living in her home. He also wants to start a life in Phoenix where he and his girlfriend from the reservation can be together.  

Matt is an experienced fancy dancer and has been dancing since he was 5-years old. He has years of experience competing at pow-wows and was able to make money for he and his mother to live from and to afford his dance regalia. After moving to Phoenix, he attended an exhibition dance to try out for his long-held dream to dance with the Native American dance troupe Indigenous Enterprise.

However, after the try outs he felt dizzy, nauseated, and weak. His aunt drove him to the Indian Health Service – Phoenix Indian Medical Center emergency room, where she knew Matt could be seen based on a sliding-fee scale as Matt has not found a job in Phoenix and has no health insurance.

After conducting several tests, the emergency room doctor diagnosed Matt with type 2 diabetes. Matt was surprised to learn he had been diagnosed with type 2 diabetes, as he is not overweight, and he knew this was a disease normally found later in adulthood. He also knows his mother, friends, and extended family on the reservation who also have type 2 diabetes who have struggled to live with the disease.

The emergency room doctor has asked for a public health nursing assessment to be done as soon as possible to assess Matt’s lifestyle, nutritional status, activity level, community supports, and teaching needs related to his new diagnosis. You are the public health nurse experienced in health care for adolescents and have been asked to visit Matt at his aunt’s home in Phoenix. Before setting up a home visit to meet Matt, you want to prepare.

To prepare for this home visit, answer the following questions:

1. Summarize what is known about the history and presence of type 2 diabetes on the Tohono O’oodham and Pima reservations. List and describe important information you would like to understand before meeting with Matt to discuss his diagnosis.
2. List and describe the life stressors that are occurring for Matt. Using a holistic approach explain how stress can impact diabetes.
3. Describe how you as a public health nurse will approach a visit with Matt who is 18-years old. Describe specifically how the visit will be different than meeting with an adult with the same diagnosis. Identify developmental considerations you will make as you facilitate a discussion with Matt and what you will do to include those considerations in your discussion.
4. You would like to learn more about Matt’s areas of need and his strengths during your first visit. After your health assessment is complete, you would like to highlight and support Matt’s strengths towards health, well-being, and managing his life with type 2 diabetes. What strengths can you identify from what you have learned today? 
5. Identify at least three culturally based community referrals you could provide to Matt and his aunt to support his health and well-being. How can his culture be a support to him now? Explain your views and provide rationale for your answers. Knowing Matt’s cultural background and goals for the future, is there anything else you would like to recommend for Matt to support him as he begins his life in Phoenix? 

Root cause of health inequity

Centuries of US federal policy that has threatened natural Native American kinship and family structure and forced assimilation of Native Americans into the White culture. Also, “…health outcomes for Native Americans are adversely impacted by wholly inadequate access to comprehensive health services” (Smith, 2022).

Policy Considerations

1. National strategy related to developing Native American youth leaders.
2. Prepare Native American youth with political knowledge and skills to further their abilities as national and tribal leaders, such as training in financial literacy, resiliency, community wellness, policy identification and developments.
3. Increase funding for tribal colleges
   • https://collegefund.org
   • https://theconversation.com/tribal-colleges-empower-native-students-with-an-affordable-culturally-relevant-education-but-need-more-funding-160578
4. Greater protection of and maintaining traditional Native American languages, sacred lands, and traditional lifeways
5. Create data institutes on Native American youth to discuss policy development on data quality and data use

Calls to Action

• Explore the conditions needed to support Native youth, their identity and worldview as a mentor.
• Include the voices of Native youth in leading change.

References

National Congress of American Indians. (2021). Native children’s policy agenda: Putting first kids 1^st. https://www.ncai.org/resources/ncaipublications/Aug_2015_Native_Childrens_Policy_Agenda.pdf

National Congress of American Indians. (2021). Native youth programs. https://www.ncai.org/native-youth

Martin, L. & Moss, M. (2016).Life in the urban setting for AI/AN adolescents. In M. Moss (Ed.) American Indian health and nursing (p. 301-304).Springer.

Schulz, L. O. & Chaudhari, L. S. (2015, March). High-risk populations: The Pimas of Arizona and Mexico. Current Obesity Reports, 4(1), 92-98. doi:10.1007/s13679-014-0132-9.