Native Americans and reservation inequality
Native American reservation inequality underlies a range of societal issues that affect the lives of Native American populations residing on reservations in the United States. About one third of the Native American population, about 700,000 persons, lives on an Indian Reservation in the United States. Reservation poverty and other discriminatory factors have led to persisting social inequality on Native American reservations. Disparities between many aspects of life at the national level and at the reservation level, such as quality of education, quality of healthcare, substance abuse, teenage pregnancy, violence, and suicide rates are significant in demonstrating the inequality of opportunities and situations between reservations and the rest of the country.
- 1 Historical discrimination
- 2 Education
- 3 Healthcare
- 4 Substance abuse
- 5 Teenage pregnancy
- 6 Violence against Native women
- 7 Suicide rates
- 8 See also
- 9 References
Many contemporary disparities are rooted in the history of Indian reservations. The reservation system was created following the expansion of the United States into tribal lands throughout the 19th and 20th centuries, during United States territorial acquisitions. This effort started with the Amari Act of 1830, which created the first reservations as Natives were forced to leave their homelands to make way for white settlers. As forced relocation progressed, many tribes lost aspects of their traditional lifestyles, which centered around community living and hunting and gathering.
Reservations were created on lands that were deemed worthless to white settlers, meaning they were often uncultivatable, resource deficient, and isolated from urban centers and transportation networks. The main result of this reservation system history is concentrated poverty on the reservations. Regardless of urbanness, areas of concentrated poverty tend to have higher crime rates, underperforming schools, poor housing, poor health conditions, limited private services, and few job opportunities., as is evidenced on many reservations.
The Indian Self-Determination and Education Assistance Act (ISDEAA) resulted from culminating civil rights movements and calls for increased attention on Native American Affairs. # According to the Bureau of Indian Affairs, (BIA), the act “gave authority to federally recognized tribes to contract with the BIA for the operation of Bureau-funded schools and to determine education programs suitable for their children.”  Later federal educational amendments furthered the capabilities of reservation schools and “provided funds directly to tribally operated schools, empowered Indian school boards, permitted local hiring of teachers and staff,” and more.
Contemporary Reservation School Situations
Schools on Native American reservations are disproportionately underachieving compared to other schools. According to a report made to the U.S. Department of Education “only 17% of tribally controlled schools made Annual Yearly Progress under No Child Left Behind during the 2007-2008 school year."  Much of the reasoning for this discrepancy is because of the widespread and disproportionate amount of reservation poverty. Consequently, "students from low socioeconomic families face unique academic challenges, as their families may lack access to the resources and socialization experiences necessary to adequately prepare and support student achievement in school"  Furthermore, "the lack of academically successful role models and the need to provide additional financial support to the family contributed to the high number of dropouts among Native American students who live in poverty." 
Both student and teacher attrition are major issues in reservation schools as well. Censuses have demonstrated the trend in reservation schools that, "despite a growth in population... enrollment in grades 1 through 12 has steadily declined..."  The High School dropout rate for Native Americans is high, much higher than the national average, and as quoted in a UCLA Civil Rights project report, “Native students “...have a dropout rate twice the national average; the highest dropout rate of any United States ethnic or racial group. About three out of every ten Native students drop out of school before graduating from high school both on reservations and in cities (p. 1).””
Teachers are also remarkably and especially difficult to retain at reservation schools, which creates problems with regularity in the classroom and many administrative difficulties as well. There are many reasons for poor teacher retention, mainly problems in “poverty, hunger, ignorance, and disease”, as Reyhner’s Teaching American Indian Students book argues, that discourage teachers when students are unable or unwilling to perform or even come to school. One of the implications of high teacher turnover is the lack of administrative stability it causes. Administrative stability is very important to long-range planning and crucial to the success of the school and its students.
Healthcare on Native American reservations faces many barriers to success. Genetic predisposition to many diseases as well as significant lack of government funding, lack of medical resources, and isolation from more populated areas with more medical resources, contribute to healthcare difficulties on reservations.
Native Americans have biological genetic predisposition to be especially susceptible to several diseases and ailments. According to a 1997 study, “with the exception of cardiovascular diseases and cancer, the risk of death from most causes are higher among Native Americans than the total US population.”.
Diabetes mellitus is an especially large factor in Native American healthcare. Studies show that “rates of diabetes and its complications…are substantially higher among Native Americans than among the US general population, and he frequency of diabetes among Native Americans is increasing.” This increase is proposed to be based upon, as the same study states, “several potentially modifiable factors, including obesity, dietary composition, and physical inactivity.” It is estimated that diabetes afflicts 40%-50% of adults in Native American communities, compared with the national average of around 8%. Multiple studies, including one presented in the American Journal of Epidemiology, describe the incidence of diabetes in the Pima Indians to be 19 times greater than a comparable white majority population.
However, more than genetic predisposition plays a significant role the afflictions of Native American populations. According to the 1997 study, “genetic susceptibility plays a significant role in some diseases, such as diabetes, while for others, the generally lower socioeconomic status, higher prevalence of certain health risk behaviors and lower utilization of preventative services in the Native American population are important determinants.”.
Lack of support
The lack of preventative medicine knowledge and resources, specifically, contributes to and exacerbates the medical predispositions of many Native Americans. The lack of research done on, and the lack of attention paid to Native Americans and reservation healthcare is part of the problem. A study done by the Agency for Healthcare Research and Quality found that “only 42% of measures of health care quality and access tracked in the National Healthcare Disparities Report could be used to assess disparities among American Indians and Alaska Natives.” The same source also argued that “data from American Indians and Alaska Natives need to be improved to allow better targeting of interventions to reduce health care disparities and monitoring the success of these activities.” 
Indian Health Service
The Indian Health Service is a federal program whose purpose is to provide medical service and support to Native Americans. The service covers all members of federally recognized tribes, over 4 million people. While it receives significant federal funds in the billions of dollars, this is still several times less than what it should be, as estimated by tribal leaders.
Additionally, federal spending cuts have slashed the program down another $800,000 this year with sequestration cuts, further reducing the already under-funded program and further exacerbating the issues of healthcare in for Native Americans.
The use of drugs, alcohol, and cigarettes on reservations is higher on Native American reservations than the national averages. According to research on alcoholism in Native American populations, “the problem of alcohol abuse is now defined as one that is both foreign to and destructive of the traditional culture”  Native American youth show higher rates of drinking and drug use than most other racial or ethnic groups and those that live on reservations are at the highest risk of developing alcohol related problems. According to Kunitz study on alcoholism in Native American populations, reasons for the prevalence of alcoholism and alcohol consumption on reservations is attributable to “access to alcohol became much easier, and patterns of drinking that had not been particularly problematic in the past began to have measurable consequences in respect of morbidity and mortality.”  Such consumption and addiction is especially prevalent on reservations. Another explanation for the prevalence of alcoholism on reservations is advertising and the responsibility of beer and alcohol manufacturers and distributors.
Marijuana and prescription drug use for Native American teens are twice the national average and young people have been shown to start experimenting with alcohol at the age of 14. The onset of alcohol usage before the age of 15 has been found to be associated with lower achievement, academic problems, drug use and alcoholism later in life.
Alcoholism in Native American populations has been shown to be associated with development of disease, including sprains and muscle strains, hearing and vision problems, kidney and bladder problems, head injuries, pneumonia, tuberculosis, dental problems, liver problems, and pancreatitis. Alcoholism death rates among young Native Americans is 3.4 deaths per 100,000, over ten times the national average of 0.3 deaths per 100,000 of the general population. Though alcohol usage varies by region and tribal affiliation, there remains a high risk factor for all Native American populations and particularly those on Native American reservations.
Teenage Pregnancy among the Native American population represents the third highest birth rate in the United States with 59 per 1,000 births in 2007. Between 2005 and 2007 the birth rate among Native Indian teen girls increased 12%, more than twice the national increase in teenage pregnancy. Rates of teenage pregnancy however differ by geographic region and tribal affiliation. Teen pregnancy of 15- to 19-year-old women in the Navajo Tribe have among the highest rates of teenage pregnancy, 15.8% higher than the national average.
Contraceptive use among Native American teenagers
Native American populations show some of the lowest documented rates of contraceptive use in the United States. A recent health study shows that 65% of males and 57% of females report having sexual intercourse by the 12th grade. Only 40% and 50% respectively report always using contraceptives and more than one third of males and one half of females had sex without contraceptives between the 7th and 9th grade. 7% of females in a study of Native American schools report incidences of pregnancy but rates are skewed due to school drop out rates. Data from the ADD Health Survey conducted on students of Bureau of Indian Affairs schools show that high school students from schools on Native American land are more likely to have had sexual intercourse when compared to the national rates of high school students. In general Native youth are more likely to have sexual intercourse at a younger age compared to their peers and are less likely to have used contraception the last time they had sex compared to their peers.
The low rates of contraceptive use are sometimes attributed to a historical disinclination of public discussions of sexuality and perceptions of shame associated with sexual behavior. Additionally access to sexual health organizations and family planning centers on Native American reservations remains limited.
Consequences of teenage pregnancy in Native youth
The high concentration of poverty and extreme poverty on Native American reservations has potentially severe consequences for pregnant teenagers. These negative consequences include educational deficits, economic strain, poor marital outcomes, as well as slowed cognitive, social, and physical development in children of adolescent parents. In 2006, 90% of teenage pregnancies among Native teenagers aged 15 to 19 were to unmarried mothers. Single parent, female headed households are at higher risk of impoverishment with almost 41% of all single parent female headed households in the United States residing below the national poverty line.
The recent rise in teenage pregnancy in Native Teen populations coupled with the already high rates of poverty on Native American Reservations has potentially detrimental consequences for Native families. A Study completed by the United States Department of Agriculture found Native American young mothers on reservations show a tendency to begin prenatal care later than their peers. They were also found to have higher rates of substance abuse during pregnancy and are more likely to have diabetes during pregnancy. Native Americans on reservations in particular showed greater rates of participation in public assistance services and their children suffered higher rates of nutritional, dietary, and clinical risks than children not born on the reservation. Advocates suggest the implementation of policies and programs that will delay sexual initiation and improve contraceptive use among Native teenagers as a possible solution to the rising rates of teen pregnancy.
Violence against Native women
Native American women have the highest rates of violent crime victimization, more than double that of other racial groups. In the violent acts committed against Native women, Native American women are more likely to have injuries that require medical attention than crimes committed against other races. They are also more likely to face an armed assailant than female victims of violent acts of other races. On a number of Native American reservations Native Women are murdered at a rate representing ten times the national average. Violent crime rates over all on Native American reservations are 2.5 times the national average while some individual reservations reach 20 times the national average of violent crime.
These high rates of gendered violence have in recent years been the subject of international attention. The United Nations Special Rapporteur on the Rights of Indigenous Peoples cited the rates of violence against women as one of the most pervasive human rights violations in the world and represented an international human rights crisis.
Scholars suggest that historically, physical and sexual violence in Native American communities was rare in Pre-Colonial society. Traditional gender roles advocated co-dependence, where women's contributions were honored and respected and where violence against Native women was heavily punished by Native justice systems.
Colonial and Post-colonial changes in Native American society spurred transformations in these traditional perceptions of gender norms and Native American societal structure. The General Allotment Act of 1887 allocated private lands to male heads of household that belied many traditions of maternal land inheritance. Women also were denied access to farming responsibilities that took away venues for accruing leadership and honor within the community.
The conversion of traditional names to Christian names in the evangelical movement to Christianize Native populations also decreased female gender status. The historical tracing of lineage through maternal lines were changed to follow kinship ties through the father's last name. These changes in gender norms are suggested to contribute to the high rates of violent crimes against Native American women.
Sexual assault and Native women
According to the National Violence Against Women Survey, 34% of American Indian and Alaskan Native women have suffered attempted or completed rape within their lifetimes. This is greater than the 18% of white women, 19% of African American women and 7% of Asian and Pacific Islander women that completed the survey. In South Dakota, only 10% of the population is Native American but Native women make up 40% of all sexual assault cases in the state. Similarly, Alaska Natives make up only 15% of the population but represent 61% of victims of reported sexual assault cases.
While nationwide most sexual offences are intra-racial or between members of the same race, the sexual offences against Native American women and Alaskan Native women are more often committed by white offenders. 1/3 of sexual offences committed against Native women are intra-racial.
Obstructions to legal action
Although violent crime and sexual assault rates are high in Native American reservations, prosecution for these crimes is relatively low. In 2007, on the Navajo Nation, of the 329 rape cases reported among a population of 180,000 individuals, only 17 arrests were made in five years. In 2011, of all rape cases reported on Native American reservations the Justice Department only prosecuted 65%. Correspondingly, Native American reservations have a high proportion of sex offenders within the population.
The low prosecution rates and rates of arrest result from numerous factors. Native American women have extremely low rates of reporting sexual assault. Some women's advocacy groups in Native American communities suggest that only 10% of all sexual offences are reported. Many Native women report feelings of betraying the community by coming forward, especially if the non-Native court systems are involved. Native Women also report a lack of faith in the local law enforcement to make arrests and prosecute offenders.
Even when sexual assaults are reported to the authorities, prosecution is not certain. According to a study by Amnesty International in 2006, the local police often either do not respond to a sexual assault case or take hours or days to respond to the victims reports. Additionally due to the overlapping jurisdiction of tribal, state, and federal authorities, enforcement of protection orders for victims remains largely unreliable. Tension between these three groups hinders responsiveness and efficiency in the prosecution of sexual offenders and the protection of the victims.
Tribal authorities also have limited jurisdiction over the prosecution of non-native offenders. 46% of the Native American reservation population are non-natives. As of 1978, under the Supreme Court case Oliphant v. Suquamish Indian Tribe, tribal courts are denied inherent jurisdiction to criminally prosecute non-natives. Tribal governments therefore have limited powers of legal processes over a significant portion of the resident population. This has negative impacts due to the high rates of intra-racial sexual assaults against Native American women.
The re-authorization of the Violence Against Women Act (VAWA) spurred controversy among the Native American community in 2012. The act, having expired, lent itself to revisions in the United States House of Representatives and the United States Senate. The Senate's re-authorization worked to eliminate some of the limitations on criminal jurisdiction of the tribal courts. In the summer of 2012, the Republican majority in the House of Representatives proffered a separate re-authorization of VAWA. The House re-authorization stripped tribal protections from the jurisdiction of tribal courts. The House's Bill would disallow Indian tribal courts from accusing non-natives on the grounds of domestic violence within reservations.
President Obama's White House administration vowed to veto any re-authorization of VAWA that failed to include the tribal protection clause. On February 28, 2013, President Barack Obama received the Senate's re-authorization of VAWA after a vote passing the act in both the House of Representatives and the Senate.
Native American and Alaskan Native populations have disproportionately high rates of homicide and suicide, particularly among younger populations. Between 1979 -1992, 2,394 individuals who lived in or near a reservation committed suicide. This represents 1.5 times the national average during these 14 years. Since 1950 the suicide rate among 15-24 year old Native American youths has increased between 200% and 300%. This rate is higher than other racial groups, making Indian youth suicide rates 2 to 3 times the rates nationwide. Suicide rates are greatest especially among Native American males following the general trends of gender and suicide.
Suicide rates vary depending on region and tribal affiliation but rates are particularly high in the Southwestern United States, the northern Rocky Mountains and Great Plains, and in Alaska. High suicide rates are often correlated with drug use, alcoholism, depression, and poverty, widespread in many native American reservations. Studies have shown that early substance abuse can lead to higher homicide and suicide rates among a population group.
Risk factors for suicide often include a sense of hopelessness, alcohol abuse, depression, poverty and a triggering conflict or event which can include conflict or loss. Among 77% of males that attempted or completed suicide had incomes of less than 10,000 dollars and 79% were unemployed. Native American youth also report higher rates of exposure to violence and sexual and physical abuse, both correlated to suicide rates. Other possible contributing factors include the mother's age at delivery, family conflict, and financial instability. Additionally 20% of all individuals who attempted or completed suicide had a parent who had also attempted or completed suicide.
Community-based programming has been shown to effectively alleviate some of the risk factors on Native American reservations associated with suicide. These programs have been proven to decrease substance abuse and increase communal connections and support.
- Modern social statistics of Native Americans
- Reservation poverty
- American Indian alcoholism
- Methamphetamine and Native Americans
- Native American disease and epidemics
- Indian reservations
- Native Americans in the United States
- List of Indian reservations in the United States
- Native American boarding schools
- Cultural assimilation of Native Americans
- Bureau of Indian Affairs
- National Congress of American Indians
- Harvard Project on American Indian Economic Development (2008). The State of Native Nations: Conditions Under U.S. Policies of Self-Determination. New York: Oxford University Press.(accessed April 18, 2013).
- McCormick, Anita (1996). Native Americans and the Reservation in American History. Berkeley Heights, NJ: Enslow Publishers.
- Wilson, James (2000). The Earth Shall Weep: A History of Native America. New York: Grove Press.
- Kneebone, Elizabeth; Carey Nadeau; Alan Berube (November 2011). The Re-Emergence of Concentrated Poverty: Metropolitan Trends in the 2000s (PDF). Washington, DC: Brookings Institution.
- "BIA Website." Indian Affairs. N.p., n.d. Web. 20 Oct. 2013.
- Gentry, M. and Fugate, C. M. (2012), Gifted native American students: Underperforming, under-identified, and overlooked. Psychol. Schs., 49: 631–646. doi: 10.1002/pits.21624
- Faircloth, Susan C., and John W. Tippeconnic III. "The Dropout/Graduation Crisis among American Indian and Alaska Native Students: Failure to Respond Places the Future of Native Peoples at Risk." Civil Rights Project/Proyecto Derechos Civiles (2010).
- (Cotton, Kathleen. Reducing Teacher Turnover in Reservation Schools: A Guide for Administrators. Portland, Or.: Northwest Regional Educational Laboratory, 1987. Print.)
- Reyhner, Jon, ed. Teaching American Indian students. University of Oklahoma Press, 1994.
- Noren J, Kindig D, Sprenger A. Challenges to Native American health care. Public Health Rep 1998;113(1):22–33.
- Recent Health Trends in the Native American Population. T. Kue Young. Population Research and Policy Review , Vol. 16, No. 1/2, Demography of American Indians and Alaska Natives (Apr., 1997), pp. 147-167. Springer in cooperation with the Southern Demographic Association.
- Diabetes Mellitus in Native Americans: The Problem and Its Implications. K. M. Venkat Narayan. Population Research and Policy Review , Vol. 16, No. 1/2, Demography of American Indians and Alaska Natives (Apr., 1997), pp. 169-192. Springer in cooperation with the Southern Demographic Association.
- Roubideaux, Yvette. "Perspectives on American Indian Health." American journal of public health 92.9 (2002): 1401-1403.
- "Diabetes Basics." Diabetes Statistics. N.p., n.d. Web. 06 Nov. 2013.
- Knowler, William C., et al. "Diabetes incidence and prevalence in Pima Indians: a 19-fold greater incidence than in Rochester, Minnesota." American Journal of Epidemiology 108.6 (1978): 497-505.
- Roxanne Andrews, et al. "Gaps In Data For American Indians And Alaska Natives In The National Healthcare Disparities Report." American Indian & Alaska Native Mental Health Research: The Journal Of The National Center 13.1 (2006): 52-69. Academic Search Complete. Web. 20 Oct. 2013.
- Editorial Board (March 20, 2013). "The Sequester Hits the Reservation" (Editorial). The New York Times. Retrieved March 28, 2013.
- Clarke, Ardy (January 2002). "Social and Emotional Distress among American Indian and Alaska Native Students: Research Findings". ERIC Digest.
- Research on alcohol use in native American populations. Stephen J. Kunitz. Health Transition Review , Vol. 7, No. 1 (APRIL 1997), pp. 85-87. National Centre for Epidemiology and Population Health (NCEPH), The Australian National University.
- Early-Onset Alcohol Use among Native American Youth: Examining Female Caretaker Influence. Melissa L. Walls, Les B. Whitbeck, Dan R. Hoyt and Kurt D. Johnson. Journal of Marriage and Family, Vol. 69, No. 2 (May, 2007), pp. 451-464. National Council on Family Relations.
- Disparities in Patterns of Alcohol Use Among Reservation-based and Geographically Dispersed American Indian Populations. O'Connell, Joan M.; Novins, Douglas K.; Beals, Janette; Spicer, Paul. Alcoholism: Clinical & Experimental Research. Jan. 2005, Vol. 29 Issue 1, p 107-116. 10p
- Litigating for Native American Health: The Liability of Alcoholic Beverage Makers and Distributors. Stephen P. Teret, Annie P. Michaelis. Journal of Public Health Policy, Vol. 26, No. 2 (2005), pp. 246-259
- U.S. Department of Health and Human Services. "Behavioral Health." Indian Health Service (IHS). (accessed February 21, 2013).
- "American Indians with alcohol problems have more medical conditions" Jay Shore, M.D., M.P.H., University of Colorado Health Sciences Center March 26, 2006, accessed October 7, 2009
- Relationship between Socioeconomic Status, Health Status, and Lifestyle Practices of American Indians: Evidence from a Plains Reservation Population. Allen Cheadle, David Pearson, Edward Wagner, Bruce M. Psaty, Paula Diehr and Thomas Koepsell Public Health Reports (1974-), Vol. 109, No. 3 (May - Jun., 1994), pp. 405-413. Association of Schools of Public Health.
- The National Campaign to Prevent Teen and Unplanned Pregnancy. "American Indian/Alaska Native Youth and Teen Pregnancy Prevention". (accessed February 20, 2013).
- Exploring Factors Related to Parenting Competence among Navajo Teenage Mothers: Dual Techniques of Inquiry. Rochelle L. Dalla and Wendy C. Gamble Family Relations , Vol. 46, No. 2 (Apr., 1997), pp. 113-121 Published by: National Council on Family Relations
- Snag Bags': Adapting Condoms to Community Values in Native American Communities. Brian Joseph Gilley Culture, Health & Sexuality , Vol. 8, No. 6 (Nov. - Dec., 2006), pp. 559-570 Published by: Taylor & Francis, Ltd.
- Among Native American Teenagers, Sex Without Contraceptives is Common. S. Edwards Family Planning Perspectives , Vol. 24, No. 4 (Jul. - Aug., 1992), pp. 189-191 Published by: Guttmacher Institute.
- National Women’s Law Center “POVERTY AMONG WOMEN AND FAMILIES, 2000-2010: EXTREME POVERTY REACHES RECORD LEVELS AS CONGRESS FACES CRITICAL CHOICE.” Rep. National Women's Law Center, Sept. 2011. Web. 8 Feb. 2013.
- United States Department of Agriculture. "THE CHARACTERISTICS OF NATIVE AMERICAN WIC PARTICIPANTS, ON AND OFF RESERVATIONS." United States Department of Agriculture Food and Nutrition Service. (accessed February 21, 2013).
- Dreveskracht, Ryan. "Revictimizing Native women for political purposes." Crosscut.com. (accessed February 21, 2013).
- Bachman, Ronet, Heather Zaykowski, Rachel Kallmyer, Margarita Poteyeva, and Christina Lanier. U.S. Department of Justice, "Violence Against American Indian and Alaska Native Women and the Criminal Justice." Last modified 2008. Accessed March 18, 2013.
- "Violence Against Native Women." Network News. Nevada Network Against Domestic Violence, 2009. Web. 17 Mar. 2013.
- Harper, Shelby S., and Christina M. Entrekin. Violence Against Native Women: A Guide for Practitioner Action. Publication. N.p.: n.p., 2006. Violence Against Native Women. Office on Violence Against Women and National Center of Full Faith and Credit, Fall 2006. Web. 8 Feb. 2013.
- Williams, Timothy. "For Native American Women, Scourge of Rape, Rare Justice." The New York Times, May 22, 2012, New York edition. (accessed February 21, 2012).
- "FindLaw | Cases and Codes." FindLaw | Cases and Codes. Thomson Reuters, 2013. Web. 18 Mar. 2013.
- Pear, Robert. "House Vote Sets Up Battle on Domestic Violence Bill." The New York Times, May 16, 2012, New York edition, sec. U.S. (accessed February 21, 2013).
- Davis, Susan. "Congress Sends Violence Against Women Act to Obama." USA Today. Gannett, 28 Feb. 2013. Web. 18 Mar. 2013.
- Centers for Disease Control. "Homicide and Suicide Among Native Americans, 1979-1992." Centers for Disease Control and Prevention. (accessed February 21, 2013).
- Suicide Among American Indian, Alaskan Native, and Canadian Aboriginal Youth: Advancing the Research Agenda. C. June Strickland International Journal of Mental Health , Vol. 25, No. 4 (Winter 1996-97), pp. 11-32. M.E. Sharpe, Inc.
- Wisconsin Center for Investigative Journalism. "A Tribal Tragedy: High Native American suicide rates persist." Wisconsin Watch September 21, 2010, sec. Health and Welfare. (accessed February 20, 2013).
- A Community-Based Approach to Preventing Alcohol Use among Adolescents on an American Indian Reservation Allen Cheadle, David Pearson, Edward Wagner, Bruce M. Psaty, Paula Diehr and Thomas Koepsell Public Health Reports (1974-) , Vol. 110, No. 4 (Jul. - Aug., 1995), pp. 439-447. Association of Schools of Public Health.