Project Summary/Abstract The life expectancy for American Indians (AIs) living on the Blackfeet reservation in Northwest Montana is 13 years shorter than the life expectancy of non-Hispanic Whites living in the same county, in part because of disproportionately high incidence of chronic diseases including diabetes, depression, and cardiovascular disease. While social connectedness has been shown to associate with health and disease-risk in other racial groups, in AI populations, the prospective role of social connectedness in health disparities is unknown. This has left a critical gap in knowledge regarding a potential factor which may offset enduring AI health disparities. Our previous cross-sectional work in the Blackfeet community indicates relationships between low social connectedness and health-risk factors including high levels of inflammatory cytokines, high resting blood pressure, high levels of symptoms of depression and anxiety, and poor sleep quality. Each of these outcomes is implicated in the onset and progression of the chronic diseases which disproportionately affect Blackfeet AI adults. Based on these observed relationships, it is possible that social connectedness may act as resilience factor which promotes good health in this at-risk community. To address this critical research gap, Blackfeet AI adults (n=280) will participate in a longitudinal study over 2 years in order to capture meaningful long-term changes in mental and physical health and social connectedness. With three measurements spaced evenly across the 2 years, we will track long-term trajectories of social connectedness, mental health, sleep quality, and biomarkers related to risk for inflammatory and cardiometabolic diseases, and investigate the correspondence between these trajectories (Aim 1). During Year 1, over a 14-day monitoring period, we will use an ecological momentary assessment app to deliver questions to participants’ mobile phones to investigate short-term dynamic relationships between social interactions, social connectedness, sleep quality and indices of mental health (i.e. symptoms of depression and anxiety) (Aim 2). In all of our models, we will consider cultural factors, experiences, and health- risk factors which we have been found to be relevant in our previous work with the community including childhood and historical trauma, recent trauma, perceived discrimination, alcohol use, smoking status, and medication use. The overarching goal of the proposed work is to understand prospective relationships between social connectedness and health in BF AI adults. This will be the first comprehensive, longitudinal study to investigate relationships between social connectedness and health risk factors in AIs. This knowledge could be applicable to other AI communities with similar cultural values and health disparities. Successful demonstration of associations between social connectedness and health-relevant outcomes will enable us to develop future interventions to improve social connectedness and thereby health in this vulnerable population.

Project Narrative This project addresses a critical gap in knowledge regarding the prospective role of social connectedness in shaping health for the Blackfeet American Indian community, a health disparity population. The findings from this longitudinal investigation will elucidate biopsychosocial pathways which may connect social connectedness to health-relevant outcomes in the Blackfeet community. This knowledge will inform future health interventions for the Blackfeet community and AI communities with similar values and health disparities.