Relations and Recovery: A social network analysis of Native mothers navigating substance use - Maternal morbidity and mortality is a growing public health crisis in the United States that disproportionately impacts pregnant and postpartum Native Americans (Native mothers) and, subsequently, their children and families. In Utah, the leading causes of maternal death are related to substance use, substance use disorder (SU/SUD), and mental health conditions, with many considered preventable. In response, the University of Utah has partnered with the Confederated Tribes of the Goshute Reservation to develop, implement, and evaluate CEREMONY, a perinatal clinical program for Native mothers with SU/SUD. CEREMONY is rooted in cultural practices and addresses additional structural and social barriers to engagement in care and recovery. Relationships strongly influence health behaviors and outcomes, and this is acutely pertinent for Native Americans whose traditional values and family structures emphasize community healing and kinship. However, there is a critical gap in our understanding of the social networks of Native mothers, which have not been previously well-characterized or studied, and how these networks might be important to recovery from SU/SUD. Longitudinal research on the evolution of social networks in Native mothers navigating SU/SUD could inform the development and guide the improvement of effective interventions. Through this project, I will: 1) characterize the social networks of Native mothers participating in a culturally integrated perinatal SU/SUD program, thereby enhancing my social network analysis skills; 2) assess the relationship between social network characteristics and SU/SUD and perinatal program outcomes, and 3) explore Native mothers’ perceptions of their social networks and how their networks impact their health behaviors and outcomes, further developing my qualitative and mixed methods skills. The completion of the aims outlined in this proposal will both contribute to a critical knowledge gap and provide me with an important research skill set in SU/SUD and maternal health research. Rigorous training in mixed methods design, social network analysis, qualitative methods, and biostatistics will accelerate my transition to a tenure-line independent investigator. My training plan was developed in collaboration with my Co-Sponsors to achieve the following goals: 1) form clinically relevant hypotheses and design rigorous experiments to test them, 2) develop skills in mixed methods design and social network analysis, 3) strengthen my skills in scientific writing and communication, 4) develop and demonstrate mentorship and leadership skills, and 5) maintain and strengthen clinical skills to better understand the clinical significance of my research. My interdisciplinary team of mentors will provide extensive guidance to achieve these goals, thus facilitating my progression into an independent physician-scientist researcher and leader. This fellowship will help me, a rising Eastern Shoshone physician-scientist, develop the skills required to conduct reciprocal, ethical research that honors Tribal sovereignty, knowledge, and traditions as essential tools for addressing health disparities.
