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ScholarWorks is an open access repository for the capture of the intellectual work of Montana State University (MSU) in support of its teaching, research and service missions. MSU ScholarWorks is a central point of discovery for accessing, collecting, sharing, preserving, and distributing knowledge to the Montana State University community and the world.

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Concerns About Medications for Opioid Use Disorder Among American Indian Community Members: A Qualitative Secondary Analysis
(Oxford University Press, 2025-01)
Grubin, Fiona
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Neavill, Morgan E.
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Sawyer, Tessa
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Larson, Amanda
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Maltaverne, Emily
Opioid use disorder and mortality due to opioid overdose pose significant public health problems in the United States, particularly among American Indian/Alaska Native (AI/AN) communities that experience disproportionately high rates of opioid overdose deaths. Such health inequities are related to centuries of ongoing colonization and oppression that inform social determinants of health today. Using medications to treat opioid use disorder (MOUD) has broad support among health professionals due to substantial evidence of its effectiveness and benefits to patients. However, most AI/ANs who need MOUD never receive it. This analysis sought to identify concerns related to the use of MOUD and how they inform barriers to implementing MOUD in a rural AI reservation community. Secondary analysis of qualitative data was conducted using reflexive thematic analysis. Findings reveal key themes related to conditions for when to use MOUD, recovery, distrust of Western medicine, and individual viewpoints on MOUD. Implications of these findings for reducing barriers to MOUD in AI/AN communities are discussed.
Training community members to deliver an intervention for substance use disorder: Overcoming implementation barriers in American Indian communities
(Elsevier BV, 2024-10)
Skewes, Monica C.
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Gonzalez, Vivian M.
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Stix, Amy
Introduction. Although American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP. Method. The study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol. Results. The initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream. Conclusion. The open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.
Higher temperatures are associated with increased interpersonal and self-inflicted violence-related Medicaid hospital visits in the United States
(Springer Science and Business Media LLC, 2026-01)
Parks, Robbie M.
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Flynn, Lauren
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Gu, Zifan
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Cerna-Turoff, Ilan
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Tuholske, Cascade
Limited evidence links short-term temperature increases to interpersonal and self-inflicted violence via physiological and behavioral pathways, especially among vulnerable communities. Here, we analyzed 14 years (1999–2012) of Medicaid claims (N = 332,293) for interpersonal and self-inflicted violence-related hospital visits in the United States. We compared daily hospital visits with local temperature patterns over the following six days, assessed by cause, demographics, climate region, and socioeconomic factors. We found that as heat stress rose, violence-related hospital visits also increased, especially in the first two days after higher heat stress. A 5°C increase was associated with a 1.5% [95% CI:1.1–1.9%] increase in interpersonal and a 3.7% [95% CI:1.5–5.9%] increase in self-inflicted violence visits. Though the difference across groups was not conclusive, point-estimate associations were greatest in younger individuals and ZIP Codes with higher poverty, lower educational attainment, and more non-white residents. Our results emphasize the importance of integrating mental health into heat health action plans and climate change preparedness.
Aspirin and Preterm Birth Among Pregnant People With Increased Heat Exposure
(American Medical Association, 2026-05)
Meltzer, Gabriella Y.
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Duttweiler, Luke P.
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Saleem, Sarah
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Shankar, Kartik
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Mazariegos, Manolo
Importance. Scalable interventions are urgently needed to mitigate the adverse effects of heat on pregnancy and newborn health. Objective. To evaluate whether low-dose aspirin modifies the association between heat exposure and preterm birth. Design, Setting, and Participants. This secondary analysis of the Global Network for Women’s and Children’s Health Research Aspirin Supplementation for Pregnancy Indicated Risk Reduction in Nulliparas (ASPIRIN) randomized, double blinded, placebo-controlled clinical trial was conducted from March 2016 to June 2018. Statistical analyses were performed from June 2024 to June 2025. The study settings included the Democratic Republic of Congo, Zambia, Kenya, Guatemala, Pakistan, and Belagavi and Nagpur, India. Participants included nulliparous individuals between 6 and 13 weeks’ gestation recruited through local clinics and communities, with delivery at 20 or more weeks’ gestation. Exposures. Prenatal care site–specific daily maximum humid heat averaged across gestation and by gestational week, and randomization to aspirin or placebo. Main Outcome and Measure. The main outcome was preterm birth (delivery between 20 and <37 weeks’ gestation) with gestational age confirmed by enrollment ultrasonography. Results. Of 11 558 participants (mean [SD] age, 20.9 [3.3] years), 5787 were randomized to receive aspirin and 5771 to receive placebo. Preterm birth occurred among 754 placebo recipients (13.1%) and 668 aspirin recipients (11.6%). In mixed-effects pooled logistic regression, each 1 °C increase in mean daily maximum shaded wet-bulb globe temperature across gestation was associated with a 5% increased odds of preterm birth (adjusted odds ratio, 1.05; 95% CI, 1.01-1.10). In stratified analyses, this increased risk was observed only among placebo recipients (adjusted odds ratio [AOR], 1.07; 95% CI, 1.02-1.13), not among aspirin recipients (AOR, 1.03; 95% CI, 0.97-1.10). In pooled mixed-effects logistic distributed lag models, increased odds of preterm birth were observed 17 to 19 weeks before delivery among individuals whose daily maximum shaded wet-bulb globe temperature exceeded the site-specific 75th percentile compared with the lowest 3 quartiles. This vulnerability was not observed among aspirin recipients. In contrast, the association of heat with perinatal mortality was observed only among those receiving aspirin (AOR, 1.15; 95% CI, 1.05-1.26) and not among those receiving placebo (AOR, 1.03; 95% CI, 0.96-1.11). Conclusions and Relevance. The findings of this secondary analysis of the Global Network ASPIRIN trial suggest that low-dose aspirin initiated early in pregnancy among nulliparous individuals may mitigate the effects of heat exposure on preterm birth. The increasing global prevalence of heat stress warrants testing its efficacy more broadly among pregnant people as well as its safety with respect to perinatal mortality.
Relationship between social support and substance use among American Indian people with a self-identified substance use problem
(American Psychological Association, 2025)
Neavill, Morgan E.
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Helm, Peter J.
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Skewes, Monica C.
Objectives: The present study sought to understand the relationship between social support and substance use among American Indian adults with substance use disorder. Method: As part of a larger community-based participatory research project, we conducted a cross-sectional survey with 198 tribal members from a rural reservation community who self-identified as having a substance use problem. We examined associations between participant substance use and social network characteristics assessed using a modified version of the Important People Drug and Alcohol interview. Results: Variables associated with greater drug and alcohol abstinence among participants included living in larger household, having a greater percentage of the household that is sober, not having attended boarding school, having a larger percentage of the social network that does not accept one’s substance use, having a smaller percentage of the social network rated as moderate or heavy substance users, and having a smaller percentage of the social network that uses substances frequently. The size, general supportiveness, and importance of the social network were not significantly associated with participant substance use. Conclusions: Network substance use behavior was a better predictor of participant substance use outcomes than general support, substance-specific support, or support for recovery/treatment.