Year of Award


Document Type


Degree Type

Doctor of Philosophy (PhD)

Degree Name

Public Health

Department or School/College

School of Public and Community Health Sciences

Committee Chair

Erin O. Semmens

Commitee Members

Annie Belcourt, Paul Smith, Tony Ward, Bonnie Stephens


University of Montana


Background: Historical and contemporary trauma among Native Americans is linked to disparate health outcomes across the lifespan including the very recent coronavirus 2019 (COVID-19) outbreak. Early and prolonged exposure to positive family-child engagement activities and the natural environment (greenspace) act as protective factors against a range of maladaptive development across the lifespan. Yet, little is known regarding specific activities relevant among high-risk families in Tribal Nations and no evidence exists in terms of measuring that impact of greenspace against risk of COVID-19 mortality.

Purpose: 1) Partner with a Tribal Nation to develop a study to identify resilience promoting factors in early childhood in the context of prenatal substance exposure (PSE); 2) Identify common positive family-child engagement activities among high-risk families; and 3) Measure the impact of greenspace and risk of COVID-19 mortality in the United States.

Methods: Community-Based Participatory Research (CBPR), strengths-based, and community-driven approaches were applied to studies one and two. The methodological study (study one; development phase) involved relationship-building to partner with one Tribal Nation and to design an epidemiological study. The qualitative study (study two; phase I) consisted of in-person semi-structured interviews with caregivers to children, ages 0-3 years, with and without PSE to identify common activities, and barriers, facilitators, and positive child outcomes to activities. The quantitative study (study three; phase II) measured greenspace exposure by leaf area index (LAI) deciles derived from 2011-2015 averaged 250 m resolution annual maximum LAI maps to assess a dose-response association with COVID-19 mortality.

Results: Study one yielded the development of a successful partnership with a Tribal Nation and a robust study design. Study two identified common cultural, community, outdoor and home activities that children engaged in with their family. Common barriers and facilitators overlapped in terms of cost, adequate transportation, safety, and family or friend presence. Positive outcomes for children were gaining cultural knowledge, bonding opportunities, and feeling soothed. Study three indicated a dose response association between high levels of LAI and lower mortality due to COVID-19.

Conclusion: Studies one and two demonstrated the impact of CBPR in engaging in research with a Tribal Nation. Study three provided evidence of a protective effect of greenspace exposure and risk of COVID-19 mortality. This research lays the groundwork for a future study that will quantify the impact of these resilience factors against social-emotional development among young children with and without PSE.



© Copyright 2021 Helen Cecelia Russette