Health inequalities between indigenous populations and the majority populations have existed in Taiwan for decades. Taiwanese indigenous peoples have a higher mortality rate than the majority populations with a life expectancy that is 8.7 years lower than the national average. Additionally, alcohol related chronic liver disease/cirrhosis and accidental injuries are 2 of the top 10 leading causes of death among indigenous peoples. Alcohol use has been one of the highest priority concerns for several indigenous communities. Historical trauma is considered as one of several determinants of alcohol use among Taiwanese indigenous communities. The Indigenist Stress Coping Model (ISCM) underscores indigenous cultures as protective factors to buffer the negative influence of historical and lifetime traumas on indigenous health outcomes (Walters & Simoni, 2002). Driven by the ISCM, this study examines whether indigenous traditional practices can interrupt the impact of historical trauma on alcohol use disorder among Taiwanese indigenous communities.
The study used a 2015-2016 cross-sectional survey among 245 indigenous tribal members (20- 83 years) who live in the East Taiwan. Alcohol use disorder was measured by the Mandarin version of the Alcohol Use Disorder Identification Test (10 items; α=0.86). Historical trauma was measured by the Intergenerational Historical Trauma Adversity Scale (9 items; α=0.86), which was designed to assess generational historical traumatic experiences among Taiwanese indigenous communities. Traditional practices were measured by the frequencies of practicing traditions and cultures that included: “practice hunting culture,” “participate in traditional ceremonies,” and “hike in traditional mountainous land.” I first conducted bivariate analyses to examine the associations among the study’s key variables. Next, I conducted structural equation modeling (SEM) to examine the hypothesized model, which proposed that traditional practices mediate the relationship between exposure to historical trauma and alcohol use disorder.
The SEM results suggested that the mediating influence of traditional practices (i.e., traditional ceremonies, hiking in traditional mountainous lands, and hunting practice) partially reduced the influence of intergenerational historical traumatic adversity on alcohol use disorder. The SEM results indicated that higher scores of intergenerational historical traumatic adversity were correlated with involvement more in traditional ceremonies (β=.20, p<.01), hunting practice (β=.35, p<.001), and hiking in traditional mountainous lands (β=.31, p<.01). These three traditional practices were also negatively associated with alcohol use disorder (β=-.13, p<.05; β=-.31, p<.01; β=-.20, p<.01, respectively). Moreover, the SEM results showed that there was a direct effect of intergenerational historical traumatic adversity on alcohol use disorder (β=.49, p=<.001). However, the total effect of intergenerational historical traumatic adversity on alcohol use disorder was decreased (β=.22, p<.01) due to the mediating influence of traditional practices. The SEM model fit the data well (RMSEA=.02, CFI=.96, TLI=.94, and χ2=102.5, p=.17).
The empirical findings of the study are consistent with the ISCM and indicate that traditional practices are important cultural protective factors to alleviate alcohol use disorders among Taiwanese indigenous communities when faced with historical trauma. To alleviate alcohol use disorder and promote healthy Taiwanese indigenous communities, future alcohol use prevention or intervention programs should consider incorporating traditional practices in culturally meaningful ways.