User:Marycneal/sandbox

Spring 2018 Human Development Project:

Summary/plan:

I plan to substantially contribute to and re-organize the article First-generation college students in the United States. I will aim to revise the article to more holistically and accurately report on the various factors that tend to shape the experiences of different individuals as first-generation college students as well as educational institutions’ responses to these experiences. I will draw from both scholarly research and other official data sources for my contributions, which will include demographic characteristics of first-generation college students in the United States (not just racial statistics, but what types of institutions they tend to attend, and how old they tend to be), the role of social mobility in framing the first-generation college student experience, characteristics of relationships between these students and their families, the "imposter phenomenon," in-college support systems commonly employed to assist these students, institutional obstacles to access that one must overcome to become a first-generation college student, and the college graduation rates of these students. Additionally, I will highlight specific population sectors of which the phenomenon of first-generation college attendance is likely to be significant, including adult learners (including at community colleges and in online classes), undocumented college students, students of rural background, Native American students, and African American students.

Work:

Characteristics section-

age: A review of the literature on first-generation college students published by the Texas Guaranteed Student Load Corporation cites a 2001 study which reported that 31% of first-generation college students were 24 years of age or older. A 1998 study cited in the same review reported that 13% of first-generation college students were 30 years of age or older. Additionally, 46% did not start attending college immediately after high school graduation, 37% were not dependents, and 18% were married.

income: Citing a 2001 study, the literature review reports that 42% of dependent first-generation college students came from the lowest family income quartile of less than $25,000 per year. A more recent statistic from a National Center for Education Statistics by Redford and Hoyer states that 27% of first-generation college students who were high school sophomores in 2002 came from households earning $20,000 or less yearly.

sex: A 1998 study found that 57% of first-generation college students were female, compared to 51% of continuing generation students.

part time: A 1998 study found that 30% of first-generation college students attend part time. A slightly more recent report from 2001 found that 44% of first-generation college students were enrolled full-time and full-year. Most recently, according to a Postsecondary National Policy Institute (PNPI) factsheets webpage cited National Center for Education Statistics (NCES) from the 2011-2012 school year, 48% of first generation college students were attending part time.

live off campus: A 1998 study found that 84% of first generation students live off campus with family members while attending college, and 56% took location factors such as the ability to live at home while studying into consideration when deciding which college to attend.

work full time: A 1998 study found that 33% of first-generation college students have a full time job while enrolled. When choosing which college to attend, 21% take into consideration the ability they will have to work while enrolled, and 21% take into consideration the ability they will have to get a job within the institution.

type of institution/degree: The literature review reports that first generation college students represented 47% of all students who began their post-secondary education in the 1995-1996 school year, 34% of those who began at a 4 year institution, 53% of those who began at a 2 year institution, and 73% of those who began at a less than two year institution. A 1998 study reported that first generation college students represented 30% of students at 4 year public institutions, 25% of students at 4 year private institutions, and 67% of students at for-profit institutions. More recently, the NCES data reported by the PNPI webpage state that of all first-generation college students in 2011-2012, 48% were enrolled in a two year institution, 25% in a 4 year institution, 19% in for-profit institutions, and 8% in distance education. The NCES report by Redford and Hoyer following students who were high school sophomores in 2002 states that 76% of first-generation college students first enrolled in public, 9% in private, and 16% in for-profit institutions. Regarding the selectively of institutions where first-generation college students tend to enroll, the same NCES report states that 52% enrolled in 2 year institutions whose selectively is unclassified. Students enrolled at moderately selective 4 year institutions comprised 16%, at inclusive 4 year institutions 9%, at unclassified 4 year institutions 9%, at unclassified less than two year institutions 9%, and at highly selective 4 year institutions 6% of the total first-generation college student population.

Social class and mobility section:

Battle and Wright, in their quantitative assessment of W.E.B. Du Bois's "Talented Tenth" in the Journal of Black Studies, discuss the conversation around higher education that took place among black intellectual leaders in the post-Reconstruction era. Du Bois's philosophy was that the cohort of emancipated slaves who would go on to become college educated, or the "Talented Tenth," had a responsibility to become leaders and advocates for the whole of the African American community. Du Bois wanted institutions of higher education to be a means by which the "humanity of African Americans" as a whole would be "recognize[d]." (Battle et al.) Later in his life, Du Bois expressed disappointment in the Talented Tenth, accusing them of using their education for personal gain and losing solidarity with the rest of the black community. In an article from the Journal of Personality and Social Psychology, Stephens et al. observe that the institution of higher education in the United States of America is viewed as and intended to be an environment of equal opportunity regardless of social class background and a means for social mobility. Rice et al., in an article in the journal Counseling Psychology Quarterly, conducted qualitative interviews with 14 first-generation college students to better understand the social class worldview and identity of first-generation college students from the students' own perspectives. When attempting to labelling their own social class, terms of social and cultural capital were more relavant than formal indicators of social class such as income, education, and occupation. Non-white first generation college students in the study would sometimes refer to their experiences using racial or ethnic terms interchangeably with class terms, showing that dimensions of their identities are not separable from one another.

Obstacles to Access:

In a 2001 US Department of Education report, Susan Choy explains that in order to becoming a college student requires a student proceed through multiple steps, starting with aspiring to earn a bachelor's degree, then achieving at least minimal academic preparation, then taking the SAT or ACT test, and finally, applying to a four-year institution. Her report shows that as a students' parents' education level increases, so does the students' likelihood of completing each step along the way to enrollment at a four-year institution. Choy also reports that the likelihood that a students will enroll in a four-year higher education institution is highly correlated with taking more advanced math courses in high school. While students whose parents had less education were less likely to take more advanced math courses, the likelihood of enrolling in college for students whose parents did not go to college greatly increases with the level of math course they take, especially if they take algebra in 8th grade.

Regrading the last step in the college enrollment process, application, the literature review by Carmen Tym et al explains that first-generation college students are not as likely to receive help from their parents nor their schools. Additionally, prospective first-generation college students are less likely to have full access to internet, an highly useful tool for researching and applying to colleges.

Bibliography of planned sources

Battle, Juan, and Earl Wright. "W.E.B. Du Bois's Talented Tenth: A Quantitative Assessment." Journal of Black Studies 32, no. 6 (2002): 654-72. http://www.jstor.org/stable/3180968.

This article discusses the phenomenon of "The Talented Tenth," a philosophy defined by W.E.B. Du Bois about the duty of individuals from       disadvantaged populations to selflessly use what privileges they earn to help and lead their communities. The article will provide useful information for examining the history of higher education of black Americans after emancipation, since this event marks a significant source of first-generation college students throughout America’s history.

Byrd, Kathleen L., and Ginger Macdonald. "Defining College Readiness from the Inside Out: First-Generation College Student Perspectives." Community College Review 33, no. 1 (2005): 22-37. doi:10.1177/009155210503300102.

This article focuses on "older first-generation college students who transferred from community college." It specifically highlights the students’ reflections on the way that their skills acquired through life experiences have transferred over to their educational endeavors.

Covarrubias, R., & Fryberg, S. A. (2015). Movin’ on up (to college): First-generation college students’ experiences with family achievement guilt. Cultural Diversity and Ethnic Minority Psychology, 21(3), 420-429. http://dx.doi.org/10.1037/a0037844

This article will help me supplement the research on first-generation college students' family relationships by comparatively examining "family achievement guilt" ("a discrepancy" between the opportunities available to the students as opposed to their family) in first-generation and continuing-generation college students.

Dumais, Susan A., Tracey E. Rizzuto, Joe Cleary, and Luke Dowden. "Stressors and Supports for Adult Online Learners: Comparing First- and Continuing-Generation College Students." American Journal of Distance Education 27, no. 2 (2013): 100-10. doi:10.1080/08923647.2013.783265.

This article presents research on the experiences of adults taking online classes, comparing the challenges faced and use of support systems by both first-generation and continuing-generation students.

"Factsheets." PNPI. Accessed February 04, 2018. http://pnpi.org/first-generation-students/.

This webpage presents data and statistics collected in the 2011-2012 academic year about the enrollment/degree attainment of as well as the challenges to first-generation college students.

Gist-Mackey, Angela N., Marissa L. Wiley, and Joseph Erba. "“You’re doing great. Keep doing what you’re doing”: socially supportive communication during first-generation college students’ socialization." Communication Education 67, no. 1 (2017): 52-72. doi:10.1080/03634523.2017.1390590.

This article also discusses the role of first-generation college students as both receivers and “agents" of social support.

Langford, J., & Clance, P. R. (1993). The imposter phenomenon: Recent research findings regarding dynamics, personality and family patterns and their implications for treatment. Psychotherapy: Theory, Research, Practice, Training, 30(3), 495-501. http://dx.doi.org/10.1037/0033-3204.30.3.495

This article examines the "imposter phenomenon," which is known to be common among first-generation college students, from a self psychological theory perspective.

Pascarella, Ernest T., Pierson, Christopher T., Wolniak, Gregory C., Terenzini, Patrick T. “First-Generation College Students.” The Journal of Higher Education 75, no. 3 (2004): 249-284. doi: 10.1080/00221546.2004.11772256.

This article examines many dimensions of first-generation college students' college experiences and outcomes. I intend to use this article to supplement the research on the types of institutions these students tend to attend.

Redford, Jeremy, and Kathleen Hoyer. "First-Generation and Continuing-Generation College Students: A Comparison of High School and Postsecondary Experiences." National Center for Education Statistics. September 26, 2017. https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2018009.

This article will help supplement the research on demographic statistics of first-generation college students. It also examines "post-secondary enrollment and completion patterns" and barriers to "obtain[ing] a credential" once enrolled that these students face.

Rice, Alexander J., Alexander J. Colbow, Shane Gibbons, Charles Cederberg, Ethan Sahker, William M. Liu, and Kristin Wurster. "The social class worldviews of first-generation college students." Counselling Psychology Quarterly 30, no. 4 (2016): 415-40. doi:10.1080/09515070.2016.1179170.

I will use this research, which interviews first-generation students about their "social-class worldview," to highlight the societal systems that motivate the pursuit of college degrees by and shape the experiences of first-generation college students.

Schmidt, J. J. and Akande, Y. (2011), Faculty perceptions of the first-generation student experience and programs at tribal colleges. New Directions for Teaching and Learning, 2011: 41–54. doi:10.1002/tl.456

This article exposes points of views of faculty at tribal colleges about the societal, familial, and financial challenges faced by first-generation students at these colleges.

Stephens, Nicole M., Hazel R. Markus, Stephanie A. Fryburg, and Camille S. Johnson. "Unseen Disadvantage: How American Universities’ Focus on Independence Undermines the Academic Performance of First-Generation College Students." Journal of Personality and Social Psychology 102, no. 6 (June 2012): 1178-197. Accessed February 4, 2018. doi:10.1037/a0027143.

This article will supplement other research in the presentation of the role of social class and mobility in the experiences of first-generation college students. It focuses on a cultural mismatch between universities and working-class backgrounds.

Tieken, Mara Casey. "College Talk and the Rural Economy: Shaping the Educational Aspirations of Rural, First-Generation Students." Peabody Journal of Education 91, no. 2 (2016): 203-23. doi:10.1080/0161956x.2016.1151741.

This article discusses the role of rural adults have in conveying messages to students about the meaning and value of college for the student and how it may affect their course of life, source of livelihood, and place of residence.

Tym, Carmen; McMillion, Robin; Barone, Sandra; Webster,  Jeff. “First-Generation College Students: A Literature Review.” Texas Guaranteed Student Loan Corporation (12 November 2004) https://files.eric.ed.gov/fulltext/ED542505.pdf

This document synthesizes a large body of research about first-generation college students. I will use its information in sections about student demographics, family relationships, in-college support systems, graduation rates, and obstacles to access.

U.S. Department of Education, National Center for Education Statistics, Students Whose Parents Did Not Go to College: Postsecondary Access, Persistence, and Attainment, NCES 2001–126, by Susan Choy. Washington, DC: 2001.

I will use this article in my contributions about obstacles to access to higher education institutions of first-generation college students as well as about their demographic makeup.

Wang, Tiffany R. "“I’m the Only Person From Where I’m From to Go to College”: Understanding the Memorable Messages First-Generation College Students Receive From Parents." Journal of Family Communication 14, no. 3 (2014): 270-90. Accessed February 4, 2018. doi:10.1080/15267431.2014.908195.

This article focuses on the types of messages received by first-generation college students about their education by their families.

Wang, Tiffany R. "Understanding the Memorable Messages First-Generation College Students Receive from On-Campus Mentors." Communication Education 61, no. 4 (2012): 335-57. doi:10.1080/03634523.2012.691978.

This article discusses the types of messages received by first-generation college students from "on-campus mentors," and will supplement other research on social support systems available to first-generation college students within the institution.

Whitehead, Patrick M., and Robert Wright. "Becoming a College Student: An Empirical Phenomenological Analysis of First Generation College Students." Community College Journal of Research and Practice 41, no. 10 (2016): 639-51. doi:10.1080/10668926.2016.1216474.

This article discusses the role of the imposter phenomenon in the identity formation of first-generation college students.

Fall 2017 PJHC Project:

Suicide among Native Americans in the United States

Suicide among Native Americans in the United States, both attempts and completion, is more prevalent than in any other racial or ethnic group in the United States.

Editing the lead:

Suicide among Native Americans in the United States, both attempted and completed, is more prevalent than in any other racial or ethnic group in the United States. Among American youths specifically, Native American youths also show higher rates of suicide than American youths of other races. Despite making up only 0.9% of the total United States population, American Indians and Alaska Natives (AIANs) are a significantly heterogeneous group, with 560 federally recognized tribes, more than 200 non-federally recognized tribes, more than 300 languages spoken, and one half or more of them living in urban areas. Suicide rates are likewise variable within AIAN communities. Reported rates range from 0 to 150 per 100,000 members of the population for different groups. Native American men are more likely to commit suicide than Native American women,  but Native American women show a higher prevalence of suicidal behaviors. The areas of interpersonal relationships, community environment,  spirituality, mental healthcare, and alcohol abuse interventions  have all been subjects of study about their effectiveness at preventing suicides. David Lester calls attention to the existence and importance of theories of suicide developed by indigenous peoples themselves, and notes that they "can challenge traditional Western theories of suicide," and points to the Mohave people's unique theory as an example. Studies by Olson and Wahab as well as Doll and Brady report that the Indian Health Service has lacked the resources needed to sufficiently address mental health problems in Native American communities.
 * 4Challenges
 * 4.1Mental healthcare
 * 4.2Reporting and research

** Taken as a whole, American Indian and Alaska Native (AIAN) rates of both suicide attempt and suicide completion are higher than any other racial/ethnic group in the United States. Despite making up only 0.9% of the total United States population, AIANs are a significantly heterogeneous group, with 560 federally recognized tribes, more than 200 non-federally recognized tribes, more than 300 languages spoken, and one half or more of them living in urban areas. Suicide rates are likewise variable within AIANs. Reported rates rang from 0 to 150 per 100,000 members of the population for different groups. The most complete records of suicide among Native Americans in the United States are reported by the Indian Health Service. ** (check possibly contradictory facts in Alcantra and Balsam about heterogeneity)

Subheading: Demographic correlations

** Suicide is the 2nd leading cause of death among AIANs ages 15-24, and the 3rd among ages 5-14 and 25-44. Adolescent and young adult AIANs are at greater risks of suicide when faced with acculturation(link) pressure. According to Alcantara, both male and female adolescents specifically are at a higher risk of suicide if they now or knew a close friend or peer who attempted or succeeded in committing suicide. Risk factors specific to adolescent males include gang participation and history of psychiatric treatment, while risk factors specific to adolescent females include access to a firearm and attendance in special education classes. Nock, in the journal Epidemiologic Reviews, explains that AIANs resemble other racial/ethnic groups in that suicide rates tend to be higher in men than in women. Nock reports that in 2005, the suicide rate for males ages increased from 9.1 at ages 10-14 to 51.9 at ages 20-24. The relative rise in suicide rates for males compared to females upon adolescence is the highest of other racial/ethnic groups in the United States. Though suicide death rates are higher in AIAN males, prevalence of suicidal behaviors in young adults and adolescents is higher in AIAN females. In a sample of Northern Plains reservation residents, females and young people had comparatively higher suicidal thoughts, plans, and attempts. In the same sample, people older than 25 were more likely to warn someone of their suicidal intentions, most likely a family member. People ages 15-24 were less likely to warn anyone, but when they did, it was most likely a friend. Berman's report shows that suicide rates among young Alaska Native men are twice as high in small rural communities than in urban areas, though rates within the rural communities are heterogeneous. Alacantara, citing a 2004 study by Freedenthal and Stiffmann of Native American youths in the Southwestern United States, reports that those who had lived two-thirds of their lives in an urban areas had lower suicidal ideation than those who had lived two-thirds of their lives on a reservation. However, there was no significant difference in lifetime attempted suicide between the urban- and reservation-reared populations. Differences in psychological risk factors were also found between the urban- and reservation-reared youth. Urban youth suicide was associated with history of physical abuse, attempt or completion by a friend, and family history of suicide. Reservation youth suicide was associated with depression, conduct disorder, cigarette smoking, family history of substance abuse, and perceived discrimination.

According to 2000-2003 data from the Center for Disease Control and the Indian Health Service, the highest suicide death rates among AIAN populations occur in the IHS service areas of Tucson, Arizona; Aberdeen, South Dakota, and Alaska and are 5 to 7 times higher than the national rate. The lowest suicide rates among IHS service areas were in California, Nashville, Tennessee, and Oklahoma. ** Alacantara gives provides examples of this heterogeneity by contrasting links to suicidal ideation found in three different tribes: one in the Southwestern, one in the Northern Plains, and one in the Pueblo region. In the Southwestern tribe, they included single-parent households and more reported life events in the last 6 months since the study. In the Northern Plains tribe, they included low self-esteem and depressive symptoms. In the Pueblo tribe, they included the suicide of a friend in the past 6 months, lower perceived social support, and depressive symptoms. **

Women:

Bohn conducted a study of the relationships between abuse, substance abuse, depression, and suicide attempts with a small sample size of 30 Native American women ranging from ages 14 to 37 who had visited an urban midwestern clinic during their 3rd trimester of pregnancy. Nine of the 30 women had attempted suicide at least once, and two of them had attempted six times. Eight of the nine had attempted for the first time or the only time as adolescents. Seven of the nine were physically or sexually abused before their suicide attempt, and five of these had been abused as children. Half of all 30 women reported a history of depression, and half reported a history of alcohol or substance abuse. Although this study had a very small sample size and cannot necessarily be fully extrapolated to all AIAN women, the National Crime Victimization Survey found that Native American women were more likely to be victims of rape/sexual assault (5.8/1000) and intimate partner violence (23.2) than American black, white, and asian women from 1993-1998.

Dillard, et. al conducted a study of a tribally owned and operated health center in Anchorage, Alaska, where a majority 58% of suicide-related visits were by women.

In a study of 212 Native youths (of the average age of 12) living on or near reservations in the upper Midwestern United States, Yoder et. al found that the girls were more than twice as likely to think of suicide than the boys.

heading: Protective factors and prevention

** Alcantara and Gone's synthesis of several studies emphasizes that the addition and strengthening of protective factors in a community is more effective at eliminating its risk of suicide than is the attempted removal of risk factors. Alcantara and Gone show that healthy, supportive relationships and strong communication between the individual and friends, family, and tribal leaders are critically instrumental in protecting against suicide risk. Among adolescent females specifically, the presence of a school nurse or clinic was shown to be a protective factor. In the American Journal of Public Health, Berman reports that lower rates of suicide among young rural Alaskan Native men were associated with areas of higher incomes, more married couples, and presence of traditional elders. Rates are also lower for communities in which either Alaskan Natives are minorities or in which there is a vast Alaska Native majority.

A report by Garroutte found that among 1,456 Northern Plains tribal members, cultural spiritual orientation was associated with less suicide attempts after controlling for age, gender, education, psychological distress, and alcohol use. Association with either cultural or Christian beliefs were not found to have a significant impact on suicide attempts.

Since alcohol misuse is the most prominent risk factor and a common precipitating factor in the general population, and even more so in AIANs, the use of prohibitionary or regulatory policies has been discussed as a potential solution. Results on its effectiveness, however, are mixed, and a study on alcohol control's effects on suicide rates in rural Alaskan communities has shown that it is an ineffective policy on its own. As reported by Olson, Native youths who cohesively identified with both Native and non-Native cultures were faced less risk of suicide. As the younger average age of first involvement with alcohol among Native youths' is a significant differentiating factor between them and non-Natives, Olson endorses substance abuse programs that influence youth very early in life. Attention to the specific community's unique needs and reliance on local leadership are also essential to substance abuse programs.

Alcantara reports that in a sample of Northern Plains American Indians, the percentage of people who had attempted suicide was greater than that of people who had exhibited suicidal ideation/planning. This information supports the use of a transactional-ecological framework for prevention, which targets the community's interaction with environmental factors as well as the environment itself, instead of person-focused interventions based on the suicide risk continuum model, in which ideation predicts attempt. Olson does endorse targeted prevention of individuals with previous attempts or ideation, along with broad public health interventions involving community collaboration. In the Jicarilla Apache community, youth suicide rates have substantially decreased since 1989, upon the implementation of a collaboration involving the Indian Health Service, tribal programs, the local high school, and local law enforcement. The commitment of a full-time staff worker was another key factor in this program's success.

Whereas Western mental health care focuses on individualized counseling, diagnosis, and prescription as a response to internalized depression, insecurity, or aggression, Native American cultural concepts emphasize external factors such as lack of harmony with nature. Gary emphasizes that culturally appropriate mental health care for Native Americans including concepts such as the Medicine Wheel, a symbol of balance, are important for preventing guilt and victimization of the mentally ill. **

Mohave:

David Lester calls attention to the existence and importance of theories of suicide developed by indigenous peoples themselves. Lester reports that the Mohave attribute suicide to "excessive individualism," or more specifically, one's dependence on and commitment to the tribal community giving way to increasing dependence on a single romantic partner. Citing Devereux, Lester explains that "The modern Mohave seems to be more involved with lovers and spouses than was the case in the past, and there is an accompanying reduction in the affective commitment to and emotional dependence on the kin group and the tribe as a whole." He goes on to explain that a Mohave individual facing alienation from romantic distress would be in danger of experiencing the same alienation as a past Mohave individual would if rejected by his or her whole tribe. Mohave tradition also holds the belief that one's chances of spending the afterlife with a loved one are stronger if the individual dies at a time soon after the death of that loved one. Funeral goers take precautions to prevent widows or widowers from attempting suicide during the ceremony, since the perceived risk is very high. When a baby is born in a "transverse position," it is traditionally thought to be simultaneously attempting to kill its mother and to commit suicide so that the mother and child will live in the afterlife together.

Challenges

Research

Treatment

Maybe include?????

Subheading: Recent rates

The National Vital Statistics Report shows that among American Indians and Alaska Natives (AIAN), the 2011 rate of death by suicide (per 100,000 members of the population) was 10.6. The rate of suicide by firearm was 4.1, and by other means was 6.5. Among males, the overall suicide rate was 16.1, the rate by firearm was 6.9, and the rate by other means was 9.2. Among females, the overall suicide rate was 5.0, the rate by firearm was 1.2, and the rate by other means was 3.7.

Data from the National Vital Statistics Reporting System shows in 2012-2013, AIAN young adults ages 18-24 had the the highest suicide rate out of all demographic groups measured, both for male and female young adults. The overall suicide rate for AIAN ages 18-24 was 22.5, for males 34.3, and for females 9.9. Data from the years 2009-2013 showed that the most common suicide method among AIAN young adults was suffocation (48.6%), followed by firearms (41.0%).

In the state of Alaska, the percentage of Alaskan Natives in a community was the single most significant predictor of suicide incidence from 2003-2011. In that time, an Alaska Section of Epidemiology study found that the suicide rate among Alaskan Natives was 40.4, more than twice that of Alaskan non-natives.

Significant underreporting of deaths in general among AIAN populations is about 30%. The cause of this underreporting is inconsistency between self-identification and death certificate racial/ethnic identification.

I will provide objective numerical data on the incidence of suicide among Native Americans, as well as specifically in Alaskan Natives. I will provide information about the contrast between suicide rates in Natives and non-Natives. I will also note the issue of significant underreporting of suicides that is likely to occur in these populations.

Subheading: Causation

I will discuss attributes of Native American history, society, and economy which lead to widespread suicidal ideation, as well as factors that are shown to correlate with lower rates of suicide.

Subheading: Challenges (to research, treatment)

Olson: The Indian Health Service lacks 50% of both staffing and funding necessary for it to adequately provide healthcare to its populations, and lacks a sufficient supply of specialized mental health workers. Among Native Americans, there are 101 mental health professionals per 100,000 people, compared to 173 for the general population. A combination of lower salaries offered by the IHS, isolated reservation locations, and seriousness and number of cases make it hard for Native American health providers to attract and retain workers. The mistaken belief that the IHS is sufficiently equipped to provide quality care endangers Native American communities to insufficient funds and protective policies. This is compounded by the near invisibility of Native Americans in government statistics due to their minuscule share of the whole population.

Olson: Because tribal boundaries are not always identical to state boundaries, so research based on state boundaries can be hindered in relevance. Research on Suicide among Native Americans in the United States often lacks large scope, large sample size, and cultural context. There is also a need for more information on suicide attempts and behaviors, not just completions. (Olson and Alcantara) Additionally, research that focuses on Native Americans as if they are a homogeneous group can problematically obscure important information that may be specific to certain regions, communities, or sectors of the population. (Olson and Alcantara)

The National Vital Statistics Report on deaths data from 2011 warns that underreporting on AIAN deaths could be as high as 30% because of race classifications on death certificates that do not match the deceased's self-reported race. (Kochanek)