Drugs and alcohol, dependence and recovery.
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Qurʾān
القرآن6 shownVerses named for this subject by hand come first. The rest are found by the subject’s own Arabic and English senses and are shown as lexical matches, not as anchors anyone has confirmed.
Qur'ān 2:219Arabic sense: الخمر, خمر | English sense: intoxicant
۞يَسۡـَٔلُونَكَ عَنِ ٱلۡخَمۡرِ وَٱلۡمَيۡسِرِۖ قُلۡ فِيهِمَآ إِثۡمࣱ كَبِيرࣱ وَمَنَٰفِعُ لِلنَّاسِ وَإِثۡمُهُمَآ أَكۡبَرُ مِن نَّفۡعِهِمَاۗ وَيَسۡـَٔلُونَكَ مَاذَا يُنفِقُونَۖ قُلِ ٱلۡعَفۡوَۗ كَذَٰلِكَ يُبَيِّنُ ٱللَّهُ لَكُمُ ٱلۡأٓيَٰتِ لَعَلَّكُمۡ تَتَفَكَّرُونَ
They ask you [Prophet] about intoxicants and gambling: say, ‘There is great sin in both, and some benefit for people: the sin is greater than the benefit.’ They ask you what they should give: say, ‘Give what you can spare.’ In this way, God makes His messages clear to you, so that you may reflect
Qur'ān 5:90Arabic sense: الخمر, خمر | English sense: intoxicant
يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُوٓاْ إِنَّمَا ٱلۡخَمۡرُ وَٱلۡمَيۡسِرُ وَٱلۡأَنصَابُ وَٱلۡأَزۡلَٰمُ رِجۡسࣱ مِّنۡ عَمَلِ ٱلشَّيۡطَٰنِ فَٱجۡتَنِبُوهُ لَعَلَّكُمۡ تُفۡلِحُونَ
You who believe, intoxicants and gambling, idolatrous practices, and [divining with] arrows are repugnant acts- Satan’s doing- shun them so that you may prosper
Qur'ān 5:91English sense: intoxicant | Arabic sense: الخمر, خمر
إِنَّمَا يُرِيدُ ٱلشَّيۡطَٰنُ أَن يُوقِعَ بَيۡنَكُمُ ٱلۡعَدَٰوَةَ وَٱلۡبَغۡضَآءَ فِي ٱلۡخَمۡرِ وَٱلۡمَيۡسِرِ وَيَصُدَّكُمۡ عَن ذِكۡرِ ٱللَّهِ وَعَنِ ٱلصَّلَوٰةِۖ فَهَلۡ أَنتُم مُّنتَهُونَ
With intoxicants and gambling, Satan seeks only to incite enmity and hatred among you, and to stop you remembering God and prayer. Will you not give them up
Qur'ān 12:41Arabic sense: خمر | English sense: wine
يَٰصَٰحِبَيِ ٱلسِّجۡنِ أَمَّآ أَحَدُكُمَا فَيَسۡقِي رَبَّهُۥ خَمۡرࣰ اۖ وَأَمَّا ٱلۡأٓخَرُ فَيُصۡلَبُ فَتَأۡكُلُ ٱلطَّيۡرُ مِن رَّأۡسِهِۦۚ قُضِيَ ٱلۡأَمۡرُ ٱلَّذِي فِيهِ تَسۡتَفۡتِيَانِ
Fellow prisoners, one of you will serve his master with wine; the other will be crucified and the birds will peck at his head. That is the end of the matter on which you asked my opinion.’
Qur'ān 47:15Arabic sense: خمر | English sense: wine
مَّثَلُ ٱلۡجَنَّةِ ٱلَّتِي وُعِدَ ٱلۡمُتَّقُونَۖ فِيهَآ أَنۡهَٰرࣱ مِّن مَّآءٍ غَيۡرِ ءَاسِنࣲ وَأَنۡهَٰرࣱ مِّن لَّبَنࣲ لَّمۡ يَتَغَيَّرۡ طَعۡمُهُۥ وَأَنۡهَٰرࣱ مِّنۡ خَمۡرࣲ لَّذَّةࣲ لِّلشَّٰرِبِينَ وَأَنۡهَٰرࣱ مِّنۡ عَسَلࣲ مُّصَفࣰّ ىۖ وَلَهُمۡ فِيهَا مِن كُلِّ ٱلثَّمَرَٰتِ وَمَغۡفِرَةࣱ مِّن رَّبِّهِمۡۖ كَمَنۡ هُوَ خَٰلِدࣱ فِي ٱلنَّارِ وَسُقُواْ مَآءً حَمِيمࣰ ا فَقَطَّعَ أَمۡعَآءَهُمۡ
Here is a picture of the Garden promised to the pious: rivers of water forever pure, rivers of milk forever fresh, rivers of wine, a delight for those who drink, rivers of honey clarified and pure, [all] flow in it; there they will find fruit of every kind; and they will find forgiveness from their Lord. How can this be compared to the fate of those stuck in the Fire, given boiling water to drink that tears their bowels
Qur'ān 12:36Arabic sense: خمر
وَدَخَلَ مَعَهُ ٱلسِّجۡنَ فَتَيَانِۖ قَالَ أَحَدُهُمَآ إِنِّيٓ أَرَىٰنِيٓ أَعۡصِرُ خَمۡرࣰ اۖ وَقَالَ ٱلۡأٓخَرُ إِنِّيٓ أَرَىٰنِيٓ أَحۡمِلُ فَوۡقَ رَأۡسِي خُبۡزࣰ ا تَأۡكُلُ ٱلطَّيۡرُ مِنۡهُۖ نَبِّئۡنَا بِتَأۡوِيلِهِۦٓۖ إِنَّا نَرَىٰكَ مِنَ ٱلۡمُحۡسِنِينَ
Two young men went into prison alongside him. One of them said, ‘I dreamed that I was pressing grapes’; the other said, ‘I dreamed that I was carrying bread on my head and that the birds were eating it.’ [They said], ‘Tell us what this means- we can see that you are a knowledgeable man.’
Research library, full list
976 to 1000 of 1,310Relationship between adverse early experiences, stressors, psychosocial resources and wellbeing.
The study examined a diathesis stress model of the relationship between adverse child experiences (ACEs), stressors and psychosocial resources to explore their relationship with wellbeing. A cross sectional study was conducted across two mental health and addiction treatment centers. 176 individuals were interviewed using a demographics form, SCID-DSM-IV(First, Spitzer, Gibbon, &Williams, 2002), Child Trauma Questionnaire (Bernstein & Fink, 1998), NEO-Five Factor Inventory (Costa & McCrae, 1992), Trait Emotional Intelligence Questionnaire (Petrides, 2009), The Coping, Inventory for Stressful Situations (CISS) (Endler & Parker, 1990), Recent Life Events Questionnaire (Department of Health, 1985) and perceived social support from family, friends and religion. Multiple, regressions and correlations were used to analyze the data. All early experiences, except physical, abuse and death of a p…
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Acculturation and perceived discrimination: predictors of substance use trajectories from adolescence to emerging adulthood among Hispanics.
Purpose: Previous studies have documented associations between cultural factors and substance use among Hispanic adolescents. Negative cultural experiences such as discrimination have been associated with an increased risk of substance use among Hispanic adolescents, whereas positive cultural resources, such as maintenance of Hispanic cultural orientations, have shown protective effects. However, few studies have examined the continuing influence of cultural factors on substance use from adolescence to emerging adulthood.
Methods: We surveyed a cohort of Hispanic adolescents in Southern California in 9th, 10th, and 11th grades, and 3-4 years after high school. Growth curve analyses were conducted to examine the effects of U.S. acculturation, Hispanic acculturation, ethnic identity, and perceived discrimination on change in tobacco, alcohol, and marijuana use over time.
Results: Higher pe…
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National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England.
Background: Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed.
Methods: A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national popul…
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Access to treatment for substance-using women in the Republic of Georgia: socio-cultural and structural barriers.
Background: In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services.
Methods: This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services.
Results: The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistan…
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Adverse childhood experiences and psychosocial well-being of women who were in foster care as children.
Background and objective: Research has shown that many children in foster care later have psychosocial problems as adults; this is often attributed to cumulative adversities and a lack of supportive caregivers. The risk factors associated with foster care, such as maternal separation and multiple placements, often counteract many protective factors that can ameliorate the effects of childhood adversities. This study assessed the relationship between adverse childhood experiences (ACEs) and psychosocial well-being in women who were in foster care as children.
Methods: A total of 101 women aged 18-71 years (mean, 36.83 [12.95] years) completed an anonymous online survey based on the 10-item ACE Questionnaire, the Sense of Coherence questionnaire, and the General Health Questionnaire.
Results: More than 56% of respondents were identified as experiencing current psychological distress. Sense…
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The impact of twelve-step program familiarity and its in-session discussion on counselor credibility.
Background and objective: The therapeutic relationship is an important factor in substance abuse treatment. Because Twelve-Step Program (TSP) concepts and principles are often incorporated into substance abuse treatment, we investigated whether counselor familiarity and time spent on TSPs impact counselor credibility.
Method: A sample of 180 clients receiving residential treatment in the capital region of a northeastern state in 2009 completed a Client Demographic Questionnaire and the Counselor Rating Form - Short Version. Their counselors (N = 31) completed a corresponding Counselor Demographic Questionnaire.
Results: The effect of the estimated percentage of in-session time discussing TSPs (p = .010) and the effect of TSP familiarity for counselors in recovery (p = .017) had significant effects on counselor credibility.
Conclusions and scientific significance: The credibility of couns…
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Development of a brief parent-report risk index for children following parental divorce.
This article reports on the development of a brief 15-item parent-report risk index (Child Risk Index for Divorced or Separated Families; CRI-DS) to predict problem outcomes of children who have experienced parental divorce. A series of analyses using 3 data sets were conducted that identified and cross-validated a parsimonious set of items representing parent report of child behavior problems and family level risk and protective factors, each of which contributed to the predictive accuracy of the index. The index predicted child behavior outcomes and substance abuse problems up to 6 years later. The index has acceptable levels of sensitivity and specificity as a screening measure to predict problem outcomes up to 1 year later. The use of the index to identify the need for preventive services is discussed, along with limitations of the study.
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Higher rates of adolescent substance use in child welfare versus community populations in the United States.
Objective: Youth substance use exacts costly consequences for a variety of important health outcomes. We examined and compared prevalence rates and a common set of psychosocial factors of lifetime and current substance use among child welfare-involved youths and community youths from two nationally representative data sets.
Method: Using the National Survey of Child and Adolescent Well-Being and the National Longitudinal Study of Adolescent Health, we compared prevalence rates and conducted logistic regression models for eight binary outcome measures of substance use: lifetime and current use of alcohol, inhalant, marijuana, and other illicit drugs to examine predictors of substance involvement in the two samples.
Results: Substance use prevalence was higher among child welfare-involved youths than community youths for lifetime marijuana use, lifetime and current inhalant use, and lifeti…
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Self-forgiveness, shame, and guilt in recovery from drug and alcohol problems.
Background: People with drug and/or alcohol problems often experience feelings of shame and guilt, which have been associated with poorer recovery. Self-forgiveness has the potential to reduce these negative experiences.
Methods: The current study tested theorized mediators (acceptance, conciliatory behavior, empathy) of the relationships between shame and guilt with self-forgiveness. A cross-sectional sample of 133 individuals (74.4% male) receiving residential treatment for substance abuse completed self-report measures of shame, guilt, self-forgiveness, and the mediators.
Results: Consistent with previous research, guilt had a positive association with self-forgiveness, whereas shame was negatively associated with self-forgiveness. Acceptance mediated the guilt and self-forgiveness relationship and had an indirect effect on the shame and self-forgiveness relationship.
Conclusions: The…
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Stimulant medication use in college students: comparison of appropriate users, misusers, and nonusers.
While stimulant medication is commonly prescribed to treat Attention-Deficit/Hyperactivity Disorder in children and adolescents (Merikangas, He, Rapoport, Vitiello, & Olfson, 2013; Zuvekas & Vitiello, 2012) and is considered an empirically supported intervention for those groups (Barkley, Murphy, & Fischer, 2008; Pelham & Fabiano, 2008; Safren et al., 2005) surprisingly little is known about the efficacy of stimulants in the slightly older emerging adult population. A focus has emerged, however, on illicit stimulant use among undergraduates, with studies suggesting such behavior is not uncommon (e.g., Arria et al., 2013). Unfortunately, details are lacking regarding outcomes and personal characteristics associated with different patterns of stimulant misuse. The current study compares the characteristics of four groups of college students, including those with stimulant prescriptions who…
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12-step participation and outcomes over 7 years among adolescent substance use patients with and without psychiatric comorbidity.
This study examines the associations between 12-step participation and outcomes over 7 years among 419 adolescent substance use patients with and without psychiatric comorbidities. Although level of participation decreased over time for both groups, comorbid adolescents participated in 12-step groups at comparable or higher levels across time points. Results from mixed-effects logistic regression models indicated that for both groups, 12-step participation was associated with both alcohol and drug abstinence at follow-ups, increasing the likelihood of either by at least 3 times. Findings highlight the potential benefits of 12-step participation in maintaining long-term recovery for adolescents with and without psychiatric disorders.
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Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: a cohort study of an urban, minority sample in the U.S.
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults. Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample. Results confirmed that there was a robust association between ACEs and poor outcomes in early adu…
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Kelly-Irving M, Lepage B, Dedieu D, Lacey R, Cable N, Bartley M, Blane D, Grosclaude P, Lang T, Delpierre C (2013)MEDLINE-indexed journal, not yet read by usBMC public health96 citations Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study.
Background: To analyse whether Adverse Childhood Experiences (ACE) are associated with an increased risk of cancer.
Methods: The National child development study (NCDS) is a prospective birth cohort study with data collected over 50 years. The NCDS included all live births during one week in 1958 (n=18558) in Great Britain. Self-reported cancer incidence was based on 444 participants reporting having had cancer at some point and 5694 reporting never having cancer. ACE was measured using reports of: 1) child in care, 2) physical neglect, 3) child's or family's contact with the prison service, 4) parental separation due to divorce, death or other, 5) family experience of mental illness & 6) family experience of substance abuse. The resulting variable had three categories, no ACEs/ one ACE/ 2+ACEs and was used to test for a relationship with cancer. Information on socioeconomic characterist…
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Reward signals, attempted suicide, and impulsivity in late-life depression.
IMPORTANCE—Suicide can be viewed as an escape from unendurable punishment at the cost of any future rewards. Could faulty estimation of these outcomes predispose to suicidal behavior? In behavioral studies, many of those who have attempted suicide misestimate expected rewards on gambling and probabilistic learning tasks. OBJECTIVES—To describe the neural circuit abnormalities that underlie disadvantageous choices in people at risk for suicide and to relate these abnormalities to impulsivity, which is one of the components of vulnerability to suicide. DESIGN—Case-control functional magnetic resonance imaging study of reward learning using are inforcement learning model. SETTING—University hospital and outpatient clinic.PATIENTS—Fifty-three participants 60 years or older, including 15 depressed patients who had attempted suicide, 18 depressed patients who had never attempted suicide (depre…
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Unbalanced neuronal circuits in addiction.
Through sequential waves of drug-induced neurochemical stimulation, addiction co-opts the brain's neuronal circuits that mediate reward, motivation to behavioral inflexibility and a severe disruption of self-control and compulsive drug intake. Brain imaging technologies have allowed neuroscientists to map out the neural landscape of addiction in the human brain and to understand how drugs modify it.
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Exploring shame, guilt, and risky substance use among sexual minority men and women.
This study examined the interrelations among shame-proneness, guilt-proneness, internalized heterosexism (IH), and problematic substance use among 389 gay, lesbian, and bisexual men and women. Problematic alcohol and drug use were positively related to shame-proneness and negatively related to guilt-proneness. Bisexuals reported riskier substance use behaviors, lower levels of guilt-proneness, and higher levels of IH than gay men and lesbians. Furthermore, study findings indicated that shame and IH are related. Additional investigations of these associations would supplement current understandings of sexual minority stress and advance the development of substance-related intervention and prevention efforts targeting sexual minorities.
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High-risk behaviour in hypomanic states.
Background: Risk-taking behaviours during hypomanic states are recognised, however the high-risk nature of some behaviours-including the potential for harm to both the individual and others-has not been detailed in the research literature. The current study examines risk-taking behaviours and their consequences (including their potential for impairment) in those with a bipolar II condition.
Method: Participants were recruited from the Sydney-based Black Dog Institute Depression Clinic. Diagnostic assignment of bipolar II disorder was based on clinician judgement and formal DSM-IV criteria. Participants completed a series of detailed questions assessing previous risk-taking behaviours during hypomanic states.
Results: The sample comprised a total of 93 participants. Risk-taking behaviours during hypomania included spending significant amounts of money, excessive alcohol or drug use, dange…
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Social, demographic, and health outcomes in the 10 years following adolescent depression.
Purpose: Little attention has been paid to the sociodemographic profiles of depressed youth during the vulnerable transition from adolescence to early adulthood. This study aimed to determine and describe the social, demographic, and health outcomes of adolescent depression during a 10-year period of transition into early adulthood, using a population-based cohort of Canadian teenagers.
Methods: Depression status on 1,027 adolescents aged 16-17 years was ascertained from the National Population Health Survey. Social and health outcomes (i.e., employment status, marital status, personal income, education, social support, self-perceived stress, heavy drinking, smoking, migraine headaches, adult depression, antidepressant use, self-rated health, and physical activity) were measured every 2 years until the ages of 26-27 years. Logistic regression was combined with a generalized linear mixed-…
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Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults.
Background: In recent years, the non-medical use of prescription drugs (NMUPD) has increased dramatically and has been associated with adverse health outcomes. Prior work has not examined this behavior in large samples of transgender adults.
Methods: Transgender adults (N=155) recruited from community venues in the Mid-Atlantic region completed anonymous, self-administered surveys assessing demographic information, NMUPD and other substance use, the non-medical use of hormones, psychosocial factors, and psychiatric symptoms.
Results: Overall, 26.5% of participants reported lifetime NMUPD with the most commonly reported medications used non-medically being prescription analgesics (23.9%), anxiolytics (17.4%), stimulants (13.5%), and sedatives (8.4%). Non-medical use of hormones was also frequently reported (30.3%). Participants reporting NMUPD were also more likely to report the use of il…
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Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand.
Objectives: Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30.
Methods: Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.
Results: After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.0…
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Repeated cocaine exposure facilitates the expression of incentive motivation and induces habitual control in rats.
There is growing evidence that mere exposure to drugs can induce long-term alterations in the neural systems that mediate reward processing, motivation, and behavioral control, potentially causing the pathological pursuit of drugs that characterizes the addicted state. The incentive sensitization theory proposes that drug exposure potentiates the influence of reward-paired cues on behavior. It has also been suggested that drug exposure biases action selection towards the automatic execution of habits and away from more deliberate goal-directed control. The current study investigated whether rats given repeated exposure to peripherally administered cocaine would show alterations in incentive motivation (assayed using the Pavlovian-to-instrumental transfer (PIT) paradigm) or habit formation (assayed using sensitivity to reward devaluation). After instrumental and Pavlovian training for foo…
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The temporal association between substance use and intimate partner violence among women arrested for domestic violence.
Objective: There is a paucity of research on the temporal association between substance use and intimate partner violence (IPV) perpetration and victimization, especially among women arrested for domestic violence. The current study examined whether the probability of IPV perpetration and victimization increases following alcohol or drug use relative to days of no use among women arrested for domestic violence.
Method: Women arrested for domestic violence and court referred to batterer intervention programs who met criteria for hazardous drinking participated in the current study (N = 105). Women who reported drinking 4 or more drinks on 1 occasion at least once per month for the past 6 months were considered hazardous drinkers. Violence and substance use were assessed with the Timeline Followback Interviews for substance use and IPV.
Results: Women were more likely to perpetrate physica…
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Prescription drug misuse, illicit drug use, and their potential risk and protective correlates in a Hispanic college student sample.
Illicit substance use has increased in Hispanics. Recent trends also warrant focus on prescription drug misuse, given its increased prevalence among college students. The aims of this study were to assess prescription drug misuse and illicit drug use in Hispanic students, as well as potential theoretically and empirically based risk and protective factors. Hispanic students (n = 435; 59% female) from a U.S. university located on the border with México completed a sociodemographic survey, licit, illicit, and prescription drug use frequency questionnaires, an attitudes and beliefs about prescription drugs survey, the Short Acculturation Scale for Hispanics, the Depression, Anxiety, and Stress Scales, the Collectivist Coping Styles Measure, and the Multidimensional Scale of Perceived Social Support. A hierarchical logistic regression assessed prescription drug misuse predictors including de…
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Alcohol misuse and relationship breakdown: findings from a longitudinal birth cohort.
Background: This study examined the associations between measures of alcohol abuse/dependence (AAD) and relationship dissolution from ages 19 to 30 in a New Zealand birth cohort.
Methods: The outcome measure was self-reported breakdown of a marital/cohabiting relationship during each year from age 20-21 to age 29-30. The study also used contemporaneous and one-year lagged measures of AAD symptoms; and time-dynamic covariate factors including life stress, other substance use, mental health status, peer and partner substance use and offending, unemployment, exposure to intimate partner violence, and prior relationship breakdown. Data were analysed using conditional fixed effects regression modelling augmented by time-dynamic covariate factors to control for confounding.
Results: Those with three or more AAD symptoms had unadjusted odds of relationship breakdown that were 2.17-2.23 times hi…
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Incorporating traditional healing into an urban American Indian health organization: a case study of community member perspectives.
Facing severe mental health disparities rooted in a complex history of cultural oppression, members of many urban American Indian (AI) communities are reaching out for indigenous traditional healing to augment their use of standard Western mental health services. Because detailed descriptions of approaches for making traditional healing available for urban AI communities do not exist in the literature, this community-based project convened 4 focus groups consisting of 26 members of a midwestern urban AI community to better understand traditional healing practices of interest and how they might be integrated into the mental health and substance abuse treatment services in an Urban Indian Health Organization (UIHO). Qualitative content analysis of focus group transcripts revealed that ceremonial participation, traditional education, culture keepers, and community cohesion were thought to b…
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