Background: The Culture is Prevention Project was initiated by 6 Urban Indian Health Organizations in response to concerns about the lack of culturally informed methods for evaluating SAMHSA funded programs.

Concerns included: a) lack of strength-based approaches; b) that government/western medical model responses to Indigenous/Native health have not proven to be very effective; and c) lack of understanding by the dominant culture that for Native Americans, culture is an important social determinant of health.

Methods: This CBPR project features 6 methodological phases where in Phases 3-4 the Cultural Connectedness Scale-California (CCS-CA) was developed and validated in a sample of 344 urban Native Americans with representation of 105 Tribes. The CCS-CA (29 items and 3 sub-scales: identity, traditions, spirituality) was paired with the Herth Hope Index (HHI) as a proxy for mental health/well-being. In Phase 5, we are recruiting adult Native Americans (N ≈ 400) to investigate the predictive properties of the CCS-CA and to further explore Native/Indigenous culture as a social determinant of health for: chronic disease, quality of life, depression, substance abuse and domestic violence.

Results/Implications: Confirmatory factor analysis indicated a good comparative fit index (CFI = .913) adequate factor loadings and good scale score reliabilities (Cronbach Alpha = .941). Correlations between CCS-CA (sub-scales) the HHI were significant and in the expected direction (increased cultural connectedness was associated with increased mental health). We conclude the CCS-CA is valid and reliable and that Native American/Indigenous culture is a social determinant of mental health/well-being. In this presentation we highlight results of the psychometric testing and present results from Phase 5. We will support the assertions/public health implications: a) since culture is a social determinant of health, that can be measured, the degree of cultural connectedness can then be considered an important program objective and viable outcome measure; and b) given that the loss of culture has negatively impacted the health/well-being of Native/Indigenous peoples, the degree of reclaimed culture or increased cultural connectedness may be a more important program objective or outcome measure, for Native American/Indigenous people, than the reductions in frequency of some risky behaviors.