School of Public Health

Native Youth Choose Life: A Protective Factors Approach

February 2018
Guest Author: Alyssa Bosold

Youth ambassadors plan, strategize, and direct activties at WeRNative to ensure messaging and topics stay relevant for adolescents and young adults.

Last summer was the first time I’d seen such a unique, upstream approach to adolescent health. In my previous public health experience – infectious disease prevention and family planning – so much of the focus was on the risk factors. But at the Northwest Portland Area Indian Health Board (NPAIHB) the emphasis is on resilience.

Protective factors are all those things that promote healthy behaviors with the potential to eliminate stressful life events

I interned with the NPAIHB, an organization that serves the 43 federally recognized tribes of Oregon, Washington, and Idaho, as a University of Washington graduate student.  I was there to develop a maternal and child health guiding framework for the Tribal Epidemiology Center. But I also had the opportunity to observe the way the NPAIHB’s program staff build protective factors that support youth in leading healthy lives. This is especially important for American Indian/Alaska Native (AI/AN) communities who face health disparities that stem from injustice and historical trauma. A recent systematic review of protective factors for AI/AN adolescent health identified: positive opportunities, connectedness to families and others, and connection to culture as most supportive. It also suggested the need for strengths-based approaches that work with adolescents to build protective factors within their communities and environments1.


In 2012, NPAIHB launched WeRNative, a multimedia resource designed and directed by youth for youth with a holistic approach that goes far beyond risk behaviors. It includes an interactive website, a texting service, and a strong social media presence that provide information about mental, physical, and sexual health, and positive relationships. WeRNative also offers information about the environment, AI/AN cultures and traditions, and has an active Q&A service called “Ask Auntie.” There are even grants available to AI/AN youth who want to lead and organize community service projects. 

What does it take to truly include youth perspective in adolescent-focused health activities?

NPAIHB consults regularly with a group of WeRNative youth ambassadors who identify relevant topics and recommend creative ways to engage with their own communities and the wider community of AI/AN youth. These ambassadors are committed to building protective factors and making positive change. Sharing her story on the website, WeRNative Ambassador Bailee Piper, Big Pine Paiute Tribe, said: “By being involved I hope to encourage younger youth to stay drug and alcohol free and to get involved in their culture and to be proud of who they are and all that they accomplish!”


NPAIHB uses a 'protective factors'-approach to address a wide range of public health problems.  Protective factors are often not as well understood as risk factors and this is especially true of suicide and suicide prevention2. Suicide is the third leading cause of death among 10 to 14 year olds, and the second leading cause of death for those 15 to 343. Among AI/AN youth, suicide rates are 1.5 times higher than the national average4

One of my first experiences as a new intern at NPAIHB was to help with the setup for the annual THRIVE youth conference. THRIVE - NPAIHB’s suicide prevention project - stands for Tribal Health: Reaching Out InVolves Everyone. The conference is a week-long event for youth aged 13 to 19 years old. It is an example of NPAIHB’s strengths-based approach and demonstrates how protective factors can be supported through public health and youth-centered programming. “The goals of the conference,” explained THRIVE Project Coordinator, Celena McCray, Navajo, “are to build protective factors and increase Native youth’s skills and self-esteem by learning about healthy behaviors, connecting with other Native youth, and how to strengthen their nation though culture, prevention, and empowerment.”

The conference draws together AI/AN youth from across the country to learn about health promotion through a series of workshops that engage their passions. While I was mostly working behind the scenes, I had the opportunity to sit in on some workshops. I watched as youth worked together to compose, record, and perform songs. Others worked on sharpening their leadership or videography skills or increasing their interest in medicine or the sciences, and all learned how to incorporate healthy choices into daily life. At the end of each workshop, youth had the opportunity to perform and share their talents in front of their peers.

THRIVE Conference youth learn to take healthy risks and step outside their comfort zone. Get a peek inside the workshops and hear from staff and teens in the THRIVE Conference video, filmed, edited, and scored by youth participants.

“We ask the kids to take healthy risk [s],” said Fish Martinez, Yurok/Modoc/Siletz/Tututni/Apache/Azteca/Shasta Tribes and co-facilitator of the ‘Beats, Lyrics, Leaders’ (BLL) Workshop at the conference. “I just feel that anything that we can do to support our youth is beneficial, so I like that there are different areas [arts and sciences]. For me personally, working in the music in BLL, I love that I get to work with some amazing artists.”  

The youth involved in THRIVE are equally enthusiastic. Terry Williams, Upper Skagit Tribe, has attended the conference for the past four years. “I’ve been opened up out of my shell,” he said. “Getting to know other people from other tribes, I think it’s a good experience. Three years ago, you take me back, I would have never talked or came here to interview. I think this conference changed my life forever.”


NPAIHB supports youth on their journey to discover and share their personal strengths. The projects offer resources so that youth can lead change in their communities and help their peers to discover their strengths as well. Overall, NPAIHB offers a successful example of how to structure and implement strengths-based public health programs and build the protective factors that can help youth maintain health and wellness throughout their lives.


Alyssa Bosold will complete her Master’s Degree in Public Health at the University of Washington in June 2018. She previously worked with the Teen Pregnancy/Parenting Coalition on the Blackfeet Reservation, served as a Public Health Associate with the CDC working with infectious disease programs in Broward County, Florida, and volunteers with Planned Parenthood. Her focus is on health equity for marginalized women and girls, especially in American Indian/Alaska Native communities, and cultural awareness and empowerment as it relates to delivery of family planning services. 


  1. Henson M, Sabo S, Trujillo A, Teufel-Shone N. Identifying Protective Factors to Promote Health in American Indian and Alaska Native Adolescents: A Literature Review. J Primary Prevent 2017; 38: 5-26.
  2. Centers for Disease Control and Prevention (CDC). Suicide Risk and Protective Factors. Updated October 3, 2017. Accessed January 10, 2018.
  3. Centers for Disease Control and Prevention (CDC). Protective Factors. Updated April 2016. Accessed January 10, 2018.
  4. Centers for Disease Control and Prevention (CDC). Suicide. Published 2015. Accessed January 10, 2018.