The resounding influence of benevolent childhood experiences

Abstract

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Keywords

childhood experiences mental health well-being

The Stress Process Model (Pearlin et al., 1981) is a foundational sociological explanation of the interplay of stressors with coping resources and responses in relation to health outcomes. A critical feature of the model is awareness of the antecedents and fundamental causes of stress (Aneshensel et al., 1991; Link & Phelan, 2005): stressor exposure is non-randomly distributed throughout society, with members of marginalized groups (e.g., those of lower socio-economic status, racial/ethnic minorities, etc.) differentially exposed to greater stress (Turner, 2010). Heightened stress exposure, in turn, increases adverse health outcomes (Pearlin et al., 1981). For American Indian and First Nations communities, fundamental antecedents of contemporary stress exposure include pervasive intergenerational oppression and associated processes of historical and ongoing colonization and marginalization (Fryberg et al., 2018; King et al., 2009; McKinley et al., 2020). This point is a centerpiece of the Indigenist Stress Coping Model (ISCM; Walters & Simoni, 2002), which beckons researchers to consider socio-historical experiences of Indigenous communities as foundational to understanding modern health inequities and disproportionate risk for stress and trauma exposure (Walters & Simoni, 2002; Walters et al., 2002). Given this backdrop, it is unsurprising that heightened stress burden (American Psychological Association, 2017; Baldwin et al., 2011) and lower life expectancy rates are observed for Indigenous peoples than are found for any other racial/ethnic group in the United States (Arias et al., 2022).

At the same time, Indigenous communities host countless strengths conducive to health and wellness (Kading et al., 2015; Kirmayer et al., 2011; Rasmus et al., 2019). The seminal works of Michael Chandler for whom this Special Issue is dedicated illuminate, for example, how Indigenous community efforts to preserve and revitalize traditional cultural ways correspond to community level well-being, including lower suicide rates (Chandler & Lalonde, 1998). Chandler and colleagues also showed how Indigenous language use confers special protective effects against suicide: in communities where more than half of Band members spoke their Native language conversationally, suicide rates were substantially lower than in those where language use was less consistent (Hallett & Chandler, 2007). These and other protective factors, including an emphasis on family and community, can serve as coping resources or buffers to offset the harmful effects of stress (Pearlin & Schooler, 1978; Walters & Simoni, 2002). While Indigenous communities consistently call for strengths-based approaches to health equity research (National Congress of American Indians et al., 2015), science to date continues a perseverance on deficits and pathology that perpetuate negative narratives about Indigenous peoples. To balance these narratives, and as a direct response to community interest in understanding drivers of positive development, we focus this study on stress process factors influencing well-being among Indigenous young adults. As detailed below, we consider two early life factors: Adverse Childhood Experiences (ACEs; a stressor), and Benevolent Childhood Experiences (BCEs; a protective factor); and two adult constructs: social support and family connections (protective factors) in our analyses.

Early life factors: Adverse and benevolent childhood experiences

In terms of stress exposure, traumatic events have been posited to have greater impacts on health than other stressors (Wheaton, 2010). The timing of traumatic events may also matter. For example, adverse childhood experiences (ACEs) have been shown to be stronger predictors of poor health than traumatic events experienced during adulthood (Wolff & Ratner, 1999). Indeed, childhood is a defining time in the life course that sets the foundation for later health and development (Elder & George, 2016). Research with Indigenous communities reveals disproportionate exposure to ACEs that are associated with negative health and behavioral outcomes in adulthood (Brockie et al., 2018; Elm, 2020; Evans-Campbell, 2008; Warne et al., 2017).

Although scientific inquiry into the prevalence and impact of ACEs has permeated the literature and informed public health practice for decades (Felitti et al., 1998; Roh et al., 2015), ACEs are only part of the story (Anda et al., 2020). ACEs-related research, policy, and practice have been critiqued for numerous reasons, including potential stigmatization and internalization of deficits narratives and labels by those who experienced ACEs (Finkelhor, 2018; Kelly-Irving & Delpierre, 2019). In part as a response to these very issues, and as a testament to Indigenous survivance (LaPier & Beck, 2015; Vizenor, 1999) and resilience, Indigenous communities have championed strengths-based research (Henson et al., 2017; Morse et al., 2016; Ullrich, 2019). A strengths-based focus has spurred many researchers to highlight pathways to well-being for Indigenous youth and adults (Friesen et al., 2015; Kading et al., 2019; Rountree & Smith, 2016; Simard & Blight, 2011). To our knowledge, this study is the first to focus on how childhood experiences may be connected to well-being of Indigenous peoples into adulthood generally or while also accounting for the realities of differential stressor exposure.

The impacts of positive childhood experiences are not left behind in childhood but carry forward into adulthood. Positive childhood experiences have been shown to support adult well-being (Sroufe et al., 2006), are associated with a reduction in adult psychosocial problems (e.g., uncontrollable anger; Hillis et al., 2010), and are promotive of physical, mental, cognitive, and social wellness even in the presence of ACEs (Crandall et al., 2019).

Traumatic and positive experiences and memories are not mutually exclusive. Even when stress and trauma are prominent in childhood, supportive parenting, positive peer relationships, and access to, and use of, community resources can produce resilience in childhood (Easterbrooks et al., 2013). Adult memories of feeling loved and cared for during childhood may co-exist with the impacts of childhood maltreatment (Narayan, Ippen, et al., 2017). One way that positive childhood experiences have been assessed is through the construct of benevolent childhood experiences (BCEs). The construct of BCEs incorporates safety, security, and positive and predictable qualities of life from birth to 18 years old (Narayan et al., 2018). In a study with low-income pregnant women, BCEs predicted lower levels of post-traumatic stress symptoms and fewer stressful life events among participants, even when accounting for ACEs (Narayan et al., 2018). In addition, and consistent with stress process models, positive childhood memories with caregivers moderated associations between childhood maltreatment and mental health outcomes in a diverse group of mothers (Narayan et al., 2019). The examination of BCEs thus provides an opportunity to assess positive early life experiences and their impact on well-being for Indigenous peoples.

Adult factors: Social support and family connections

Benevolent and adverse childhood experiences have been shown to impact people into adulthood, but it is unclear how such experiences impact well-being when considering adult experiences. Strong social support networks in adulthood may confer better health. Results from a meta-analytic review showed that pro-social relationships significantly reduced risk of mortality (Holt-Lunstad et al., 2010). When multidimensional assessments of social relationships were used, including family connections and emotional support, this association increased (Holt-Lunstad et al., 2010).

Social support and family connections in adulthood represent two major constructs robustly linked to health and well-being. Extensive evidence indicates that perceived availability of social support, rather than receipt of support or perceived responsiveness, is an important predictor of health (Berkman et al., 2000; Reis, 2007). Perceptions of available emotional support may act as a secure attachment base where an individual knows they have support they can rely on if they were to need it (Bowlby, 1988; Feeney & Collins, 2015). Family networks further support well-being for many Indigenous peoples (Martin & Yurkovich, 2014). Strong family relationships facilitate deeper connection to cultural protective factors (Ore et al., 2016) and such relationships have been shown to be salient to wellness in many studies with Indigenous people (Coser et al., 2018; Kading et al., 2019). Notably, family connections and social supports have also been shown to operate as stress-buffering factors or coping resources across cultures (Cohen & McKay, 1984; Gayman et al., 2018; Schultz et al., 2021).

Well-being

Much research with Indigenous communities has focused on the important work of understanding the relationships between historical trauma, ongoing experiences of oppression and racism, and symptoms of depression, loneliness, and anxiety (Evans-Campbell, 2008; O’Keefe et al., 2015; Yellow Horse Brave Heart et al., 2011). However, mental health is not merely the absence of mental illness; rather mental health and mental illness are separate unipolar dimensions and need to be addressed as such (Keyes, 2005). For example, Walls et al. (2016) found that levels of positive mental health among Indigenous Peoples were equal to or greater than comparison studies with non-Indigenous populations even in the presence of comparatively higher rates of anxiety and depressive symptoms. In parallel to the concepts of flourishing or positive mental health, as measured by Keyes (2005) and Walls et al. (2016), is the construct of well-being (Diener et al., 2018; Ryff, 1989). Well-being entails self-perceived success in areas such as capability, purpose, and optimism (Diener et al., 2010). In this article, we take a holistic view of the impact of childhood experiences on adult mental well-being among Indigenous young adult participants.

To solely focus on ACEs without giving similar attention to BCEs and positive adulthood factors sends a message that the impacts of ACEs are destiny and amplifies the power of deficits-driven narratives about Indigenous communities. Congruously, focusing solely on either BCEs or ACEs does not consider impacts across life-course development or offer ways to improve outcomes. In this study, we examine associations between ACEs, BCEs, and adult protective factors with respect to Indigenous well-being in young adulthood (Figure 1A and C). Drawing upon the Stress Process Model and the ISCM, we further examine the potential for BCEs (an early life protective factor) and early adult family satisfaction and social support to moderate the impact of ACEs on adult well-being (Figure 1B).

Figure 1.

Conceptual model. Note: (-) denotes expected inverse relationships. Line B represents expected stress-buffering (moderating) associations.

Our analyses account for three control variables: gender (females have been shown to experience greater psychological distress than males; Kessler, 2002); income (those with higher income have been shown to have greater well-being; Mirowsky & Ross, 2003); and relationship status (current relationship status has been linked to well-being, such that those in committed or stable relationships tend to have better mental health than those who are not; Braithwaite et al., 2010; Girme et al., 2016).

Methods

Participants

Participants are from the Healing Pathways study, a longitudinal, community-based participatory research panel study with Indigenous families from four reservations in the upper Midwestern United States and four reserves in Ontario, Canada. The baseline sampling procedure (2002) involved contacting all families with a tribally enrolled adolescent aged 10–12 living on, or within, 50 miles of participating reservations/reserves. Interviewers received training in human subjects’ protection and conducting paper and pencil surveys. Trained interviewers contacted participants and completed in-person survey interviews annually from 2002–2010 (average adolescents, 11–18 years old), then re-contacted participants in 2017 when the average age was 26 years. Data for the current analyses are derived from the 453 young adult participants interviewed at wave 9 of the study (2017–2018). Participants received a $50 visa gift card or check at the completion of the interview. Community Research Council (CRC) members are involved in all aspects of study design, implementation, and data dissemination. All participating reservations/reserves granted Tribal Resolutions to support this work and all study procedures and materials were approved by the University of Minnesota institutional review board.

Measures

Survey development processes for the study included intensive CRC brainstorming meetings and pilot sessions during which Indigenous community members provided feedback on comprehension and validity of various survey items. In addition, CRC members met regularly over the course of several months to review drafts of survey documents. They provided the university team feedback on cultural and community “fit” or relevance of measures, offered suggestions for improving local understanding/wording, and nominated survey items for addition or deletion.

Dependent variable

Well-being was measured using an adapted version of the Flourishing Scale (Diener et al., 2010). Respondents were asked how strongly they agreed with 8 items related to self-perceived success in areas of well-being such as relationships, self-esteem, purpose, and optimism. Examples include, “I lead a purposeful and meaningful life,” and “I am optimistic about my future.” Item scores ranged from 0 (strongly disagree) to 4 (strongly agree). Items were summed to create a final variable (range 0−32) with higher values indicating greater well-being (α = .89). The Flourishing Scale has been shown to be both reliable and valid in studies involving thousands of people across many cultures and among diverse age groups (De la Fuente et al., 2017; Diener et al., 2010; Martín-Carbonell et al., 2021; Romano et al., 2020; Tong & Wang, 2017). This scale has demonstrated high convergence with other psychological well-being measures including Deci and Ryan's Basic Need Satisfaction in General Scale and Ryff's Scale of Psychological Well-Being (De la Fuente et al., 2017; Diener et al., 2010; Martín-Carbonell et al., 2021; Romano et al., 2020; Tong & Wang, 2017).

Independent variables.

Benevolent childhood experiences (BCEs) were measured using an adapted version of the Benevolent Childhood Experiences scale (Narayan et al., 2018). Members of CRCs provided intensive feedback to suggest removing two of the original items from the measure. The resulting items assess favorable experiences that occur between birth and 18 years old and are characterized by perceived safety, security, and support, and positive and predictable qualities of life. Examples include, “Did you have beliefs that gave you comfort?” and “Did you have at least one caregiver who you felt safe with?” Response options were no (0) or yes (1). We conducted a confirmatory factor analysis of a single latent variable in MPLUS and factor loadings were >.40 once “Did you have a predictable home routine, like regular meals and a regular bedtime?” was removed. Items were summed to create a final BCE score.

Adverse childhood experiences (ACEs) were measured using an adapted version of the Adverse Childhood Experiences – International Questionnaire (World Health Organization, 2018). To maximize validity of the measure for the contexts in which this research takes place, slight modifications driven by CRC input were made to the ACEs questionnaire. For example, question stems that started with “did you see …” were changed to “how often did you see …” when the response options asked for frequency of experiences. Items used in this study assessed for exposure to eight adversities that occurred during the first 18 years of life. These included child abuse (i.e., sexual, physical, and emotional abuse) and exposures typically referred to collectively as household dysfunction (i.e., divorce/separation, household violence, growing up with someone who had mental illness or a substance abuse problem, having a household member go to jail or prison). Participants were considered exposed to each adversity type if they reported ever having the experience during the first 18 years of life (1 = yes, 0 = no). ACE variables were then summed to create a continuous ACEs score index (α = .78). Participants were included in this continuous index assessment if they completed responses for at least four of the eight ACE variables.

Family satisfaction was measured using an adapted version of the Marital Satisfaction Scale (Schumm et al., 1986). Respondents were asked how satisfied they were with their relationship with their family. The item score ranged from 0 (very dissatisfied) to 4 (very satisfied).

Receiving emotional support was measured using a subscale of the 2-Way Social Support Scale (Shakespeare-Finch & Obst, 2011). Examples include, “there is at least one person that you can share most things with,” and “you feel like you have a circle of people who value you.” Items scores ranged from 0 (not at all true) to 3 (always true). Items were summed to create a final variable with higher values indicating greater experience of receiving emotional support (α = .87).

Controls.

Three demographic variables were included as controls. We relied on reports of gender at wave 1 for complete gender information. Gender was coded as female = 1; male = 0. Income was a continuous measure in thousands of dollars. Current romantic relationship status was coded as yes (in a relationship) = 1; no (not in a relationship) = 0.

Analytic strategy

A total of 12 participants were missing data on at least one variable included in the analyses and were removed from the final analyses. The final analytic sample is 441 participants. We conducted an attrition analysis of those who did not participate in the current study wave compared to those included in the analyses. Males and participants who resided off reservation/reserve land at baseline had higher odds of attrition compared to females and those who resided on reservation/reserve land at baseline. We present bivariate zero-order bivariate correlations of all variables included in the analyses. Next, we present multiple linear regression models predicting well-being. In the first model, we examine the association between ACEs and well-being controlling for demographics controls. We separately enter each of the positive coping variables individually. In the final model, we examine the joint contribution of all variables. To examine possible buffering effects between ACEs and BCEs, family satisfaction, and receiving emotional support, three interaction terms were created and tested individually.

Results

An average of 6.5 (SD = .91) BCEs were reported with 66.7% of the participants reporting experiencing all 7 possible BCEs. An average of 3.4 (SD = 2.4) ACEs were reported with 86% reporting at least 1 ACE (Table 1).

Table 1.

Descriptive statistics (N = 441).

	M (SD)
Wellbeing	24.04 (4.38)
Adverse childhood experiences	3.46 (2.40)
Benevolent childhood experiences	6.48 (0.90)
Family satisfaction	3.19 (1.09)
Receive emotional support	9.07 (3.02)
Female	0.58
Income	$18,191.61 (13,528.85)
In romantic relationship	0.60

Table 2 present the bivariate correlations of all variables included in the analyses. The major predictor variables (i.e., early life and adulthood stress/coping factors) were all significantly associated with well-being at the bivariate level in expected directions (i.e., ACEs negatively associated and protective factors positively associated with well-being). ACEs were negatively associated with BCEs, family satisfaction, and receiving emotional support. BCEs, family satisfaction, and receiving emotional support were all positively associated with one another.

Table 2.

Correlations matrix (N = 441).

	(1)	(2)	(3)	(4)	(5)	(6)	(7)
(1) Flourishing
(2) ACEs	−0.16*
(3) BCEs	0.30*	0.19*
(4) Family satisfaction	0.40*	−0.20*	0.33*
(5) Receive emotional support	0.49*	−0.16*	0.25*	0.41*
(6) Female	0.01	0.16*	−0.01	−0.05	0.11*
(7) Income	0.25*	−0.01	0.07	0.20	0.33*	0.01
(8) In romantic relationship	0.18*	0.07	0.05	0.08	0.22*	0.10*	0.20*

*p < .05.

Table 3 presents the regression models predicting well-being. In Model 1, ACEs were negatively associated with well-being (β = −.17; p < .01) controlling for demographics. In Models 2–4, BCEs, family satisfaction, and receiving emotional support were added to the models individually. In each of these models, ACEs remained negatively associated with well-being, but the association attenuated. The models with family satisfaction and receiving emotional support showed the largest decreases in the association between ACEs and well-being, compared to the model with BCEs. In Model 5, all variables were included. ACEs were no longer associated with well-being. BCEs (β = .14; p < .01), family satisfaction (β = .19; p < .001), and receiving emotional support (β = .33; p < .001) were positively associated with well-being. We tested for possible buffering interactions between ACEs and BCEs, family satisfaction, and receiving emotional support. None of these interactions were significant (results not shown).

Table 3.

Regression models predicting well-being (N = 441).

	Model 1	Model 2	Model 3	Model 4	Model 5
	b (SE)β	b (SE)β	b (SE)β	b (SE)β	b (SE)β
Adverse Childhood Experiences	−0.31 (.08) −0.17**	−0.22 (0.08) −0.12**	−0.18 (0.08) −0.10*	−0.16 (0.08) −0.09*	−0.08 (0.07) −0.04
Benevolent Childhood Experiences		1.27 (0.22) 0.26***			0.69 (0.21) 0.14**
Family satisfaction			1.37 (0.18) 0.34***		0.76 (0.18) 0.19***
Receive emotional support				0.62 (0.07) 0.43***	0.47 (0.07) 0.33***
Female	0.23 (0.41) 0.03	0.19 (0.39) 0.02	0.31 (0.38) 0.03	−0.24 (0.37) −0.03	−0.11 (0.36) −0.01
Income	0.07 (0.01) 0.22***	0.07 (0.01) 0.21***	0.05 (0.01) 0.16***	0.03 (0.01) 0.10*	0.03 (0.01) 0.08
In romantic relationship	1.31 (0.41) 0.15**	1.20 (0.22) 0.26***	1.14 (0.39) 0.13**	0.62 (0.07) 0.43***	0.68 (0.37) 0.07
Constant	22.89 (0.50)	14.49 (1.51)	18.50 (0.74)	18.10 (0.68)	12.24 (1.40)
R ²	0.10	0.17	0.21	0.25	0.31

*p < .05; **p < .01; **p < .001.

Discussion

The expansive body of ACEs research has revolutionized our understanding of early life stress and trauma and how the effects of such can last a lifetime (Merrick et al., 2017; Roh et al., 2015). However, this body of work is not without challenges (Anda et al., 2020; Lacey & Minnis, 2020), and such narratives when applied to groups like Indigenous peoples can perpetuate erroneous and stigmatizing narratives of victimization, ignoring positive lived experiences and important work in advocacy and social change (LaPier & Beck, 2015; Vizenor, 1999). Key factors of individual and community well-being include protective and stress buffering effects, which can be considered in tandem using stress process theoretical frameworks.

This work empirically identifies select stress process factors from across the life course and is rooted in stress process models of health that have implications for improving well-being within Indigenous communities. We support the call for strengths-based research from tribal communities and acknowledge that narratives of strength and well-being are much needed (Kading et al., 2019; National Congress of American Indians et al., 2015). This study responds to this call and findings are a step toward balancing deficits-based research about Indigenous families. We are not alone in this regard: the work of Dr. Michael Chandler highlighted throughout this Special Issue was among the earliest to empirically examine Indigenous strengths. His innovative approach included recognizing Indigenous community assets and active efforts to preserve cultural strengths as “cultural continuity,” and to tie such continuity to positive population-level health outcomes (Chandler & Lalonde, 1998).

Among participants, 86% reported at least one ACE. This is consistent with other studies’ reports of one or more ACE among American Indian participants (82% in Brockie et al., 2018; 83% in Koss et al., 2003; 86% in Warne et al., 2017). Adverse childhood experiences are an important consideration for future well-being, yet they are only part of the story. Indeed, the strength of association between ACEs and young adult well-being was weaker than that between BCEs and well-being. In addition, the sizes of the correlation coefficients for BCEs with adulthood protective factors were larger than correlations between ACEs and these same protective factors. Thus, while ACEs are associated with fewer adult assets like family satisfaction and emotional support, BCEs were correlated even more strongly with these protective mechanisms. These findings amplify the need to delineate stressors and protective factors and outcomes in the stress process and clarify how each of these may have different impacts. It could be that ACEs (or other stressors) are more strongly associated with negative outcomes, while BCEs (or other protective factors and/or stress-buffering resources) may be more strongly associated with positive outcomes, a topic worthy of additional inquiry in stress process studies.

Results of this study reveal very high occurrences of positive early life experiences in the form of BCEs among study participants. Although some measurement differences caution comparisons to other studies, BCEs reported here are much higher than found in prior literature (Narayan et al., 2018). Our study uses an adapted questionnaire with 7 out of the original 10 BCEs; 66.7% of the Healing Pathways wave 9 participants reported experiencing all of the BCEs measured. Studies that have used the 10 item scale have found that 39% and 27.7% of the participants reported experiencing all of the BCEs, respectively (see Crandall et al., 2019; Narayan et al., 2018). Paralleling these findings, prior studies have revealed other important strengths in the form of mental health outcomes in Indigenous communities and communities of color. For example, Walls et al. (2016) found disproportionately high rates of psychological well-being (even amidst elevated rates of depressive symptoms) across two distinct Indigenous samples compared to findings from previously published studies with non-Native groups. Further, Keyes (2009) found paradoxically high levels of “flourishing” mental health status among Black Americans, despite differential exposure to structurally rooted stressors like discrimination. An important message is revealed by this line of research: when we take the time to measure positive outcomes and protective factors in diverse communities, we in turn observe them. Indeed, the centrality of community strengths and connectedness are hallmarks of Indigenous frameworks of well-being (Ullrich, 2019) and such cultural values likely propel the elevated levels of BCEs we observed.

Strengths-based research and perspectives have shown the important distinction between mental health and mental illness, and that health is not merely the absence of disease (Kading et al., 2015, 2019; Keyes, 2005). Health paradoxes have been observed among Black Americans who experienced better mental health compared to White Americans despite experiencing greater stressors (Keyes, 2009) and Indigenous communities who experienced flourishing mental health coupled with heightened psychological distress (Walls et al., 2016). Just as the absence of mental illness does not equal mental health (Keyes, 2005), the presence of mental illness, or psychological distress, does not prevent mental health (Walls et al., 2016). Our findings extend this framing to include other positive experiences that are conducive to well-being. That is, BCEs and ACEs are not mutually exclusive (Narayan, Ippen, et al., 2017), and BCEs exemplify survivance, an active sense of resistance, presence, and endurance (Vizenor, 1999). In the midst of historical oppression, lived experiences include the reality and opportunity for positive factors. Reducing risk and promoting strengths are both important to well-being.

Our findings also suggest that BCEs are associated with well-being beyond childhood, even when considering ACEs and positive adult experiences. The association between ACEs and young adult well-being dropped from statistical significance after accounting for positive childhood and adult experiences. There are a few ways this could be interpreted: (1) adult positive experiences may attenuate the impacts of ACEs on well-being; (2) BCEs may interact with adult positive experiences in additive effects to impact well-being.

Family satisfaction and receiving emotional support were robust predictors of adult well-being in our multivariate models and this is a promising point for promoting well-being. While the onslaught of colonization resulted in far reaching disruption of family systems among Indigenous communities, traditional and contemporary values and practices in many Indigenous communities reinforce the interconnectedness of individuals, family, community, and spirituality. Connectedness is posited as “one of the keys to Indigenous survival and well-being” in direct opposition to colonization (Ullrich, 2019, p. 121). The impact of family satisfaction on adult well-being may be especially pronounced because of the value placed on family connections as well as the broad nature of what family entails among many Indigenous communities (Kading et al., 2019; Martin & Yurkovich, 2014). Further, our results expand the importance of emotional support for well-being among Indigenous communities (Richmond et al., 2007). These analyses used select childhood and adult stress process factors to determine associations with well-being. While childhood experiences are important associations with adult well-being, a balanced picture of both positive and negative childhood and adult stress process factors is necessary to have the greatest understanding of the associations with well-being. These results may have important implications for understanding how these factors operate to impact well-being.

The impacts of childhood experiences on adult well-being are not destiny. For those who have experienced ACEs and lack emotional support and family satisfaction in adulthood, there are still opportunities to foster wellness. Involvement in traditional spiritual and cultural activities and connectedness to family, nature, and community have been found to be protective for mental and physical health among Indigenous populations (Bear et al., 2018; Brockie et al., 2018; Chandler & Dunlop, 2015; Chandler & Lalonde, 2008; Kading et al., 2015). Additionally, select therapeutic approaches have shown promise for improving emotional, social, and cognitive indicators among adults who have experienced ACEs (Korotana et al., 2016). Thus, for those adults who have experienced ACEs and lack emotional support or family satisfaction, increased engagement in cultural and spiritual activities, as well as seeking out appropriate therapeutic opportunities, may strengthen well-being.

Limitations and future research

This study showed that BCEs were positively associated with well-being. However, there are additional factors, such as language use, traditions, and environmental and spiritual connection, which are not included in the BCE scale that have been shown to be protective for health among Indigenous populations (Gonzalez et al., 2017; Ullrich, 2019). Relatedly, an important part of our community-based participatory research (CBPR) approach is collaborative measurement development and adaptation. Based on community feedback, our team adapted and included 8 of 10 possible BCE indicators (one of which was removed from analyses based on factor analysis findings—see Results section) from the original source measure. Moreover, there was a ceiling effect with the BCE measure in that most respondents reported all 7 BCEs. This lack of variability precludes examination of whether there are tipping points with BCEs where protective effects are most pronounced. Additionally, we recognize that, while the Flourishing Scale (Diener et al., 2010) includes a constellation of factors widely considered vital for well-being, this measure is limited in its capacity to fully encompass holistic well-being and may not incorporate culturally relevant components specific to Indigenous communities. There is considerable need for measurement development and evaluation work to develop Indigenous-centric measures of BCEs and well-being, assess psychometric properties of these novel measures, and improve the relevance of such indicators to diverse Indigenous contexts.

In this study, we were unable to determine the temporal ordering of ACEs and BCEs. Future research could better establish timing of ACEs and BCEs, as well as examine mediation and moderation of outcomes. This study involved retrospective reporting of ACEs and BCEs among a cohort of young adult participants. This may have led to underestimates, or overestimates, of the occurrence of each of these kinds of childhood experiences.

The impact of BCEs extending across the life course has yet to be determined. Just as ACEs can be intergenerational (Narayan, Kaltabakken, et al., 2017), it is possible that BCEs may persist across generations. These intergenerational pathways may operate through using benevolent childhood memories as examples for positive methods of interaction with subsequent generations, as well as adult support networks that encourage and support positive decisions (Lieberman et al., 2005; Schofield et al., 2013). Future research is needed to explore the intergenerational pathways of BCEs.

Conclusion

This article responds to the call for strengths-based research with Indigenous communities and takes a holistic approach to examining influences on adult well-being by looking at select childhood and adult stress process factors. By illuminating the abundant presence of BCEs experienced by the majority of study participants, this study contributes to a body of work that uplifts the strengths of Indigenous communities and combats dominant, deficit-based narratives about Indigenous families (Gray et al., 2019; Kading et al., 2019; Martin & Yurkovich, 2014). In demonstrating the influence of BCEs and adult positive experiences on adult well-being, even in the presence of ACEs, this study provides possible directions for interventions to promote adult health and well-being.

Footnotes

Acknowledgements

The authors would like to thank the Community Research Council members and interviewers of the Healing Pathways team: David Bruyere, Laura Bruyere, Annabelle Jourdain, Priscilla Simard, Trisha Bruyere, Jake Becker, Laureen Hill, Frances Whitfield, GayeAnn Allen, Tina Handeland, Victoria Soulier, Bagwajikwe Madosh, Betty Jo Graveen, Clinton Isham, Carol Jenkins, Bill Butcher Jr., Delores Fairbanks, Devin Fineday, Bernadette Gotchie, Gloria Mellado, Marilyn Bowstring, Gary Charwood, Gina Stender, Darold Madigan, Kathy Dudley, Geraldine Brun, June Holstein, Frances Miller, Brenna Pemberton, Ed Strong, Barbara Thomas, Charity Prentice-Pemberton, FaLeisha Jourdain, Penny King, Valerie King, Linda Perkins, Christie Prentice, Gabe Henry, Howard Kabestra, Dallas Medicine, Glenn Cameron, Jackie Cameron, Gerilyn Fisher, Virginia Pateman, Irene Scott, Cindy McDougall, Chantel King, Whitney Accobee, Celeste Cloud, Pat Moran, Stephanie Williams, Natalie Bergstrom, Bonnie Badboy, Elizabeth Kent, Sue Trnka, and Laurie Vilas. The authors would also like to thank Lucas Kosobuski for his work on the references.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: research reported in this manuscript is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number DA039912 (M. Walls, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ORCID iD

Kaley A. Herman

Kaley Herman, BA, is a Research Affiliate of the Johns Hopkins Center for Indigenous Health, Great Lakes Hub. Ms. Herman oversaw data management, software maintenance, and project monitoring for Healing Pathways. Her published works focus on mental health, mental illness, coping resources and responses, and social support among Indigenous communities.

Dane Hautala, PhD, is an Assistant Scientist in the Department of International Health and Center for Indigenous Health at the Johns Hopkins Bloomberg School of Public Health. His published work focuses on substance use, mental health, and well-being from early-adolescence to young adulthood among North American Indigenous communities.

Kevalin Aulandez, MSPH, CD(DONA), is an Associate Faculty in the Department of International Health at Johns Hopkins University. Ms. Aulandez's work focuses on culturally-centered approaches to preventing chronic diseases and on using policy, systems, and environmental levers to foster health equity. Her published works focus on culture as a source of strength and healing for addressing diabetes and COVID-19 in Indigenous communities.

Melissa Walls, PhD (Bois Forte and Couchiching First Nation Anishinaabe), is a Bloomberg Associate Professor of American Health in the Department of International Health at Johns Hopkins University and Co-Director of the Center for Indigenous Health. She strives to work in authentic collaborative relationships with Indigenous communities to advance health equity in culturally safe ways. She has engaged in Indigenous health research partnerships for over 20 years on topics including mental health epidemiology; culturally relevant, family-based substance use prevention and mental health promotion; and examining the impact of stress and mental health on diabetes and related health outcomes.

References

American Psychological Association. (2017). Stress and health disparities: Contexts, mechanisms, and interventions among racial/ethnic minority and low socioeconomic status populations [Data set]. American Psychological Association, APA Working Group on Stress and Health Disparities. https://doi.org/10.1037/e500202018-001

Anda

R. F.

Porter

L. E.

Brown

D. W.

(2020). Inside the adverse childhood experience score: Strengths, limitations, and misapplications. American Journal of Preventive Medicine, 59(2), 293–295. https://doi.org/10.1016/j.amepre.2020.01.009

Aneshensel

C. S.

Rutter

C. M.

Lachenbruch

P. A.

(1991). Social structure, stress, and mental health: Competing conceptual and analytic models. American Sociological Review, 56(2), 166–178. https://doi.org/10.2307/2095777

Arias

Tejada-Vera

Kochanek

Ahmad

(2022). Provisional life expectancy estimates for 2021 (Vital Statistics Rapid Release, Report No. 23). Centers for Disease Control and Prevention. https://doi.org/10.15620/cdc:118999

Baldwin

J. A.

Brown

B. G.

Wayment

H. A.

Nez

R. A.

Brelsford

K. M.

(2011). Culture and context: Buffering the relationship between stressful life events and risky behaviors in American Indian youth. Substance Use & Misuse, 46(11), 1380–1394. https://doi.org/10.3109/10826084.2011.592432

Bear

U. R.

Garroutte

E. M.

Beals

Kaufman

C. E.

Manson

S. M.

(2018). Spirituality and mental health status among Northern Plain tribes. Mental Health, Religion & Culture, 21(3), 274–287. https://doi.org/10.1080/13674676.2018.1469121

Berkman

L. F.

Glass

Brissette

Seeman

T. E.

(2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843–857. https://doi.org/10.1016/S0277-9536(00)00065-4

Braithwaite

S. R.

Delevi

Fincham

F. D.

(2010). Romantic relationships and the physical and mental health of college students. Personal Relationships, 17(1), 1–12. https://doi.org/10.1111/j.1475-6811.2010.01248.x

Brockie

T. N.

Elm

J. H. L.

Walls

M. L.

(2018). Examining protective and buffering associations between sociocultural factors and adverse childhood experiences among American Indian adults with type 2 diabetes: A quantitative, community-based participatory research approach. BMJ Open, 8(9), Article e022265. https://doi.org/10.1136/bmjopen-2018-022265

10.

Bowlby

. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

11.

Chandler

Dunlop

W. L.

(2015). Cultural wounds demand cultural medicines. In M. Greenwood, S. de Leeuw, & N. M. Lindsay (Eds.), Determinants of Indigenous peoples’ health: Beyond the social (2nd ed.). CSP Books.

12.

Chandler

Lalonde

(1998). Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcultural Psychiatry, 35(2), 191–219. https://doi.org/10.1177/136346159803500202

13.

Chandler

Lalonde

(2008). Cultural continuity as a protective factor against suicide in First Nations youth. Horizons, 10(1), 68–72. https://www.researchgate.net/publication/239921354_Cultural_Continuity_as_a_Protective_Factor_Against_Suicide_in_First_Nations_Youth

14.

Cohen

McKay

. (1984). Social support, stress and the buffering hypothesis: A theoretical analysis. In Taylor

S. E.

Singer

J. E.

Baum

(Eds.), Handbook of psychology and health: Vol. IV (pp. 253–267). Routledge.

15.

Coser

Sittner

K. J.

Walls

M. L.

Handeland

(2018). Caregiving stress among American Indians with Type 2 diabetes: The importance of awareness of connectedness and family support. Journal of Family Nursing, 24(4), 621–639. https://doi.org/10.1177/1074840718810550

16.

Crandall

Miller

J. R.

Cheung

Novilla

L. K.

Glade

Novilla

M. L. B.

Magnusson

B. M.

Leavitt

B. L.

Barnes

M. D.

Hanson

C. L.

(2019). ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health. Child Abuse & Neglect, 96, 89–104. https://doi.org/10.1016/j.chiabu.2019.104089

17.

De la Fuente

Parra

Sánchez-Queija

(2017). Psychometric properties of the Flourishing Scale and measurement invariance between two samples of Spanish university students. Evaluation & the Health Professions, 40(4), 409–424. https://doi.org/10.1177/0163278717703446

18.

Diener

Oishi

Tay

(2018). Advances in subjective well-being research. Nature Human Behaviour, 2, 253–260. https://doi.org/10.1038/s41562-018-0307-6

19.

Diener

Wirtz

Tov

Kim-Prieto

Choi

Oishi

Biswas-Diener

(2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156. https://doi.org/10.1007/s11205-009-9493-y

20.

Easterbrooks

M. A.

Ginsburg

Lerner

R. M.

(2013). Resilience among military youth. Future of Children, 23(2), 99–120. https://doi.org/10.1353/foc.2013.0014

21.

Elder

G. H.

George

L. K.

(2016). Age, cohorts, and the life course. In M. Shanahan, J. Mortimer, & M. Kirkpatrick Johnson (Eds.), Handbook of the life course (Vol. 2, pp. 59–85). Springer International.

22.

Elm

J. H. L.

(2020). Adverse childhood experiences and internalizing symptoms among American Indian adults with Type 2 diabetes. Journal of Racial and Ethnic Health Disparities, 7, 958–966. https://doi.org/10.1007/s40615-020-00720-y

23.

Evans-Campbell

(2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23(3), 316–338. https://doi.org/10.1177/0886260507312290

24.

Feeney

B. C.

Collins

N. L.

(2015). Thriving through relationships. Current Opinion in Psychology, 1, 22–28. https://doi.org/10.1016/j.copsyc.2014.11.001

25.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Koss

M. P.

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

26.

Finkelhor

(2018). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse & Neglect, 85, 174–179. https://doi.org/10.1016/j.chiabu.2017.07.016

27.

Friesen

B. J.

Cross

T. L.

Jivanjee

Thirstrup

Bandurraga

Gowen

L. K.

Rountree

(2015). Meeting the transition needs of urban American Indian/Alaska Native youth through culturally based services. The Journal of Behavioral Health Services & Research, 42(2), 191–205. https://doi.org/10.1007/s11414-014-9447-2

28.

Fryberg

S. A.

Covarrubias

Burack

J. A

. (2018). The ongoing psychological colonization of North American Indigenous People: Using social psychological theories to promote social justice. In Hammack

P. L.

(Ed.), The Oxford handbook of social psychology and social justice (pp. 113–128). Oxford University Press.

29.

Gayman

M. D.

Lennox Kail

Spring

Greenidge

G. R.

Jr. (2018). Risk and protective factors for depressive symptoms among African American men: An application of the Stress Process Model. The Journals of Gerontology: Series B, 73(2), 219–229. https://doi.org/10.1093/geronb/gbx076

30.

Girme

Y. U.

Overall

N. C.

Faingataa

Sibley

C. G.

(2016). Happily single: The link between relationship status and well-being depends on avoidance and approach social goals. Social Psychological and Personality Science, 7(2), 122–130. https://doi.org/10.1177/1948550615599828

31.

Gonzalez

M. B.

Aronson

B. D.

Kellar

Walls

M. L.

Greenfield

B. L.

(2017). Language as a facilitator of cultural connection. Ab-Original: Journal of Indigenous Studies and First Nations’ and First Peoples’ Culture, 1(2), 176–194. https://doi.org/10.5325/aboriginal.1.2.0176

32.

Gray

Schrader

Isaacs

Smith

Bender

(2019). Wac’inyeya: Hope among American Indian youth. American Indian and Alaska Native Mental Health Research, 26(2), 151–171. https://doi.org/10.5820/aian.2602.2019.151

33.

Hallett

Chandler

(2007). Aboriginal language knowledge and youth suicide. Cognitive Development, 22(3), 392–399. https://doi.org/10.1016/j.cogdev.2007.02.001

34.

Henson

Sabo

Trujillo

Teufel-Shone

(2017). Identifying protective factors to promote health in American Indian and Alaska Native adolescents: A literature review. The Journal of Primary Prevention, 38(1–2), 5–26. https://doi.org/10.1007/s10935-016-0455-2

35.

Hillis

S. D.

Anda

R. F.

Dube

S. R.

Felitti

V. J.

Marchbanks

P. A.

Macaluso

Marks

J. S.

(2010). The protective effect of family strengths in childhood against adolescent pregnancy and its long-term psychosocial consequences. The Permanente Journal, 14(3), 18–27. https://doi.org/10.7812/TPP/10-028

36.

Holt-Lunstad

Smith

T. B.

Layton

J. B.

(2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), Article e1000316. https://doi.org/10.1371/journal.pmed.1000316

37.

Kading

M. L.

Gonzalez

M. B.

Herman

K. A.

Gonzalez

Walls

M. L.

(2019). Living a good way of life: Perspectives from American Indian and First Nation young adults. American Journal of Community Psychology, 64(1–2), 21–33. https://doi.org/10.1002/ajcp.12372

38.

Kading

M. L.

Hautala

D. S.

Palombi

L. C.

Aronson

B. D.

Smith

R. C.

Walls

M. L.

(2015). Flourishing: American Indian positive mental health. Society and Mental Health, 5(3), 203–217.

39.

Kelly-Irving

Delpierre

(2019). A critique of the Adverse Childhood Experiences framework in epidemiology and public health: Uses and misuses. Social Policy and Society, 18(3), 445–456. https://doi.org/10.1017/S1474746419000101

40.

Kessler

R. C.

(2002). Gender differences in major depression. In Frank

(Ed.), Gender and its effects on psychopathology (pp. 61–84). American Psychiatric Press.

41.

Keyes

C. L. M.

(2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548. https://doi.org/10.1037/0022-006X.73.3.539

42.

Keyes

C. L. M.

(2009). The Black–White paradox in health: Flourishing in the face of social inequality and discrimination. Journal of Personality, 77(6), 1677–1706. https://doi.org/10.1111/j.1467-6494.2009.00597.x

43.

King

Smith

Gracey

(2009). Indigenous health part 2: The underlying causes of the health gap. Lancet, 374(9683), 76–85. https://doi.org/10.1016/S0140-6736(09)60827-8

44.

Kirmayer

L. J.

Dandeneau

Marshall

Phillips

M. K.

Williamson

K. J.

(2011). Rethinking resilience from Indigenous perspectives. The Canadian Journal of Psychiatry, 56(2), 84–91. https://doi.org/10.1177/070674371105600203

45.

Korotana

L. M.

Dobson

K. S.

Pusch

Josephson

(2016). A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences. Clinical Psychology Review, 46, 59–90. https://doi.org/10.1016/j.cpr.2016.04.007

46.

Koss

M. P.

Yuan

N. P.

Dightman

Prince

R. J.

Polacca

Sanderson

Goldman

(2003). Adverse childhood exposures and alcohol dependence among seven Native American tribes. American Journal of Preventive Medicine, 25(3), 238–244. https://doi.org/10.1016/S0749-3797(03)00195-8

47.

Lacey

R. E.

Minnis

(2020). Practitioner review: Twenty years of research with adverse childhood experience scores – advantages, disadvantages and applications to practice. Journal of Child Psychology and Psychiatry, 61(2), 116–130. https://doi.org/10.1111/jcpp.13135

48.

LaPier

R. R.

Beck

D. R. M.

(2015). City Indian: Native American activism in Chicago, 1893–1934. University of Nebraska Press.

49.

Lieberman

A. F.

Padrón

Van Horn

Harris

W. W.

(2005). Angels in the nursery: The intergenerational transmission of benevolent parental influences. Infant Mental Health Journal, 26(6), 504–520. https://doi.org/10.1002/imhj.20071

50.

Link

Phelan

J. C

. (2005). Fundamental sources of health inequities. In Mechanic

Rogut

L. B.

Colby

D. C.

Knickman

(Eds.), Policy challenges in modern health care (pp. 71–84). Rutgers University Press.

51.

Martin

Yurkovich

(2014). “Close-knit” defines a healthy Native American Indian family. Journal of Family Nursing, 20(1), 51–72. https://doi.org/10.1177/1074840713508604

52.

Martín-Carbonell

Espejo

Checa

Fernández-Daza

(2021). Adaptation and measurement invariance by gender of the Flourishing Scale in a Colombian sample. International Journal of Environmental Research and Public Health, 18(5), Article 2664. https://doi.org/10.3390/ijerph18052664

53.

McKinley

C. E.

Boel-Studt

Renner

L. M.

Figley

C. R.

Billiot

Theall

K. P.

(2020). The Historical Oppression Scale: Preliminary conceptualization and measurement of historical oppression among Indigenous peoples of the United States. Transcultural Psychiatry, 57(2), 288–303. https://doi.org/10.1177/1363461520909605

54.

Merrick

M. T.

Ports

K. A.

Ford

D. C.

Afifi

T. O.

Gershoff

E. T.

Grogan-Kaylor

(2017). Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse & Neglect, 69, 10–19. https://doi.org/10.1016/j.chiabu.2017.03.016

55.

Mirowsky

Ross

C. E.

(2003). Social causes of psychological distress. Transaction.

56.

Morse

G. S.

McIntyre

J. G.

King

(2016). Positive psychology in American Indians. In E. C. Chang, C. A. Downey, J. K. Hirsch, & N. J. Lin (Eds.), Positive psychology in racial and ethnic groups: Theory, research, and practice (pp. 109–127). American Psychological Association. 10.1037/14799-006

57.

Narayan

A. J.

Ippen

C. G.

Harris

W. W.

Lieberman

A. F.

(2017). Assessing angels in the nursery: A pilot study of childhood memories of benevolent caregiving as protective influences. Infant Mental Health Journal, 38(4), 461–474. https://doi.org/10.1002/imhj.21653

58.

Narayan

A. J.

Ippen

C. G.

Harris

W. W.

Lieberman

A. F.

(2019). Protective factors that buffer against the intergenerational transmission of trauma from mothers to young children: A replication study of angels in the nursery. Development and Psychopathology, 31(1), 173–187. https://doi.org/10.1017/S0954579418001530

59.

Narayan

A. J.

Kaltabakken

A. W.

Labella

M. H.

Nerenberg

L. S.

Monn

A. R.

Masten

A. S.

(2017). Intergenerational continuity of adverse childhood experiences in homeless families: Unpacking exposure to maltreatment versus family dysfunction. American Journal of Orthopsychiatry, 87(1), 3–14. https://doi.org/10.1037/ort0000133

60.

Narayan

A. J.

Rivera

L. M.

Bernstein

R. E.

Harris

W. W.

Lieberman

A. F.

(2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse & Neglect, 78, 19–30. https://doi.org/10.1016/j.chiabu.2017.09.022

61.

National Congress of American Indians, National Indian Child Welfare Association, National Indian Education Association, & National Indian Health Board. (2015). Native children’s policy agenda: Putting first kids 1st. National Indian Child Welfare Association.

62.

O’Keefe

V. M.

Wingate

L. R.

Cole

A. B.

Hollingsworth

D. W.

Tucker

R. P.

(2015). Seemingly harmless racial communications are not so harmless: Racial microaggressions lead to suicidal ideation by way of depression symptoms. Suicide and Life-Threatening Behavior, 45(5), 567–576. https://doi.org/10.1111/sltb.12150

63.

Ore

C. E.

Teufel-Shone

N. I.

Chico-Jarillo

T. M.

(2016). American Indian and Alaska Native resilience along the life course and across generations: A literature review. American Indian and Alaska Native Mental Health Research, 23(2), 134–157. https://doi.org/10.5820/aian.2303.2016.134

64.

Pearlin

L. I.

Menaghan

E. G.

Lieberman

M. A.

Mullan

J. T.

(1981). The stress process. Journal of Health and Social Behavior, 22(4), 337–356. https://doi.org/10.2307/2136676

65.

Pearlin

L. I.

Schooler

(1978). The structure of coping. Journal of Health and Social Behavior, 191, 2–21. https://doi.org/10.2307/2136319

66.

Rasmus

S. M.

Trickett

Charles

John

Allen

(2019). 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. Cultural Diversity & Ethnic Minority Psychology, 25(1), 44–54. https://doi.org/10.1037/cdp0000243

67.

Reis

H. T.

(2007). Steps toward the ripening of relationship science. Personal Relationships, 14(1), 1–23. https://doi.org/10.1111/j.1475-6811.2006.00139.x

68.

Richmond

C. A. M.

Ross

N. A.

Egeland

G. M.

(2007). Social support and thriving health: A new approach to understanding the health of Indigenous Canadians. American Journal of Public Health, 97(10), 1827–1833. https://doi.org/10.2105/AJPH.2006.096917

69.

Roh

Burnette

C. E.

Lee

K. H.

Lee

Y.-S.

Easton

S. D.

Lawler

M. J.

(2015). Risk and protective factors for depressive symptoms among American Indian older adults: Adverse childhood experiences and social support. Aging & Mental Health, 19(4), 371–380. https://doi.org/10.1080/13607863.2014.938603

70.

Romano

Ferro

M. A.

Patte

K. A.

Diener

Leatherdale

S. T.

(2020). Measurement invariance of the Flourishing Scale among a large sample of Canadian adolescents. International Journal of Environmental Research and Public Health, 17(21), Article 7800. https://doi.org/10.3390/ijerph17217800

71.

Rountree

Smith

(2016). Strength-based well-being indicators for Indigenous children and families: A literature review of Indigenous communities’ identified well-being indicators. American Indian and Alaska Native Mental Health Research, 23(3), 206–220. https://doi.org/10.5820/aian.2303.2016.206

72.

Ryff

C. D.

(1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081. https://doi.org/10.1037/0022-3514.57.6.1069

73.

Schofield

T. J.

Lee

R. D.

Merrick

M. T.

(2013). Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: A meta-analysis. Journal of Adolescent Health, 53(4, Suppl.), S32–S38. https://doi.org/10.1016/j.jadohealth.2013.05.004

74.

Schultz

Walls

Grana

S. J.

(2021). Intimate partner violence and health: The roles of social support and communal mastery in five American Indian communities. Journal of Interpersonal Violence, 36(13–14), NP6725–NP6746. https://doi.org/10.1177/0886260518821463

75.

Schumm

W. R.

Paff-Bergen

L. A.

Hatch

R. C.

Obiorah

F. C.

Copeland

J. M.

Meens

L. D.

Bugaighis

M. A.

(1986). Concurrent and discriminant validity of the Kansas Marital Satisfaction Scale. Journal of Marriage and Family, 48(2), 381–387. https://doi.org/10.2307/352405

76.

Shakespeare-Finch

Obst

P. L.

(2011). The development of the 2-Way Social Support Scale: A measure of giving and receiving emotional and instrumental support. Journal of Personality Assessment, 93(5), 483–490. https://doi.org/10.1080/00223891.2011.594124

77.

Simard

Blight

. (2011). Developing a culturally restorative approach to aboriginal child and youth development: Transitions to adulthood. First Peoples Child & Family Review, 6(1), 28. https://doi.org/10.7202/1068895ar

78.

Sroufe

L. A.

Egeland

Carlson

Collins

W. A

. (2006). Placing early attachment experiences in developmental context: The Minnesota longitudinal study. In Grossman

K. E.

Grossmann

Waters

(Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 48–70). Guilford Press.

79.

Tong

K. K.

Wang

Y. Y.

(2017). Validation of the Flourishing Scale and scale of positive and negative experience in a Chinese community sample. PLOS ONE, 12(8), Article e0181616. https://doi.org/10.1371/journal.pone.0181616

80.

Turner

R. J.

(2010). Understanding health disparities: The promise of the stress process model. In Avison

W. R.

Aneschensel

C. S.

Schieman

Wheaton

(Eds.), Advances in the conceptualization of the stress process: Essays in honor of Leonard I. Peralin (pp. 3–21). Springer.

81.

Ullrich

J. S.

(2019). For the love of our children: An Indigenous connectedness framework. AlterNative: An International Journal of Indigenous Peoples, 15(2), 121–130. https://doi.org/10.1177/1177180119828114

82.

Vizenor

(1999). Manifest manners: Narratives on posindian survivance. University of Nebraska Press.

83.

Walls

M. L.

Pearson

Kading

Teyra

(2016). Psychological wellbeing in the face of adversity among American Indians: Preliminary evidence of a new population health paradox? Annals of Public Health and Research, 3(1), Article 1034. PMID: 28553671; PMCID: PMC5443649.

84.

Walters

K. L.

Simoni

J. M.

(2002). Reconceptualizing Native women’s health: An “indigenist” stress-coping model. American Journal of Public Health, 92(4), 520–524. https://doi.org/10.2105/ajph.92.4.520

85.

Walters

K. L.

Simoni

J. M.

Evans-Campbell

(2002). Substance use among American Indians and Alaska Natives: Incorporating culture in an “Indigenist” stress-coping paradigm. Public Health Reports (1974), 117(1), S104–S117.

86.

Warne

Dulacki

Spurlock

Meath

Davis

M. M.

Wright

McConnell

K. J.

(2017). Adverse Childhood Experiences (ACE) among American Indians in South Dakota and associations with mental health conditions, alcohol use, and smoking. Journal of Health Care for the Poor and Underserved, 28(4), 1559–1577. https://doi.org/10.1353/hpu.2017.0133

87.

Wheaton

. (2010). Stressors, stress, and distress. In Scheid

T. L.

Brown

T. N.

(Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (Second Edition, pp. 171–199). Cambridge University Press.

88.

Wolff

A. C.

Ratner

P. A.

(1999). Stress, social support, and sense of coherence. Western Journal of Nursing Research, 21(2), 182–197. https://doi.org/10.1177/01939459922043820

89.

World Health Organization. (2018). Adverse childhood experiences international questionnaire. World Health Organization. https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq)

90.

Yellow Horse Brave Heart

Chase

Elkins

Altschul

D. B.

(2011). Historical trauma among Indigenous people of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(3), 282–290. https://doi.org/10.1080/02791072.2011.628913