A qualitative study of ecological factors impacting American Indian adolescents living on the Fort Peck Reservation during the COVID-19 pandemic

Introduction: American Indian communities were disproportionately impacted by the COVID-19 pandemic, with the highest COVID-19 mortality rate of all racial and ethnic groups in the United States. In particular, American Indian adolescents faced unique challenges due to the COVID-19 pandemic. Objectives: This manuscript presents the self-reported experiences, interpersonal relationship perspectives, and behaviors of American Indian adolescents aged 14 to 18 living on the Fort Peck Reservation in Northeastern Montana during the COVID-19 pandemic. Methods: Semi-structured interviews (n = 31) investigated the ecological factors influencing the American Indian adolescents during the COVID-19 pandemic, including: (1) tribal governance, economics, environment; (2) protection from COVID-19; (3) social impact of COVID-19; (4) relationships; and (5) access to services. Inductive analyses were conducted within each of these aforementioned categories. Results: Our findings suggest that participants' perspectives varied widely on how well the Fort Peck Tribes handled transmission mitigation strategies. Participants also described how the COVID-19 pandemic had a predominantly negative impact on relationships with peers and their academic performance, and a mixed impact on their ability to access services. Our most striking finding was the positive impact of the COVID-19 pandemic on family connectedness, communication within the family, and the use of traditional medicines and ceremonies among American Indian adolescents. Conclusion: These findings support the importance of promoting family connectedness, parent/caregiver-adolescent communication, and the use of traditional American Indian healing practices to mitigate risk and promote health and wellness during future pandemics.