Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University

Carson, William O.; Valenti, Michelle; Begay, Kendrick; Carvajal, Scott; Carroll, Stephanie Russo; Yuan, Nicole P.; Cordova-Marks, Felina M.

doi:10.3390/ijerph22091409

Open AccessArticle

Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University

by

William O. Carson

^1,2,*,†,

Michelle Valenti

¹

,

Kendrick Begay

^3,‡,

Scott Carvajal

¹,

Stephanie Russo Carroll

^1,3,§

,

Nicole P. Yuan

¹

and

Felina M. Cordova-Marks

^1,‖

¹

Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85721, USA

²

Native Nations Institute, Udall Center for Studies in Public Policy, University of Arizona, Tucson, AZ 85721, USA

³

College of Engineering, University of Arizona, Tucson, AZ 85721, USA

^*

Author to whom correspondence should be addressed.

^†

Ohkay Owingeh.

^‡

Navajo Nation.

^§

Native Village of Kluti-Kaah.

^‖

Hopi.

Int. J. Environ. Res. Public Health 2025, 22(9), 1409; https://doi.org/10.3390/ijerph22091409

Submission received: 14 July 2025 / Revised: 17 August 2025 / Accepted: 1 September 2025 / Published: 10 September 2025

(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness: 2nd Edition)

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Abstract

Introduction: This study examined the relationship between Indigenous identity, perceived stress, and healthcare utilization for Indigenous students on-campus. Methods: Potential participants included undergraduate and graduate Indigenous students from Tribal Nations within the United States. Participants were recruited through community partnerships and in person communication. This survey included the Perceived Stress Scale (PSS-10), the Multiethnic Identity Measure (MEIM), and university Campus Health Service Health and Wellness Survey. Results: 153 Indigenous students from United States-based Tribal Nations participated in this survey. While there appears to be a relationship between Indigenous identity, perceived stress, and Campus Health utilization, the results were not significant for the second tertile (OR: 1.1 (0.4, 2.7)) or third tertile (1.4 (0.5, 3.3)). Students who reported “Yes” or “Unsure” to questions on if their insurance needed them to go outside of the university were far less likely to use Campus Health (Yes OR: 0.2 (0.08–0.5)); (Unsure OR: 0.09 (0.03–0.3)) and CAPS (Yes OR: 0.2 (0.09–0.6)); (Unsure OR: 0.2 (0.04–0.4)). Discussion: This study saw a complex relationship between Indigenous identity, perceived stress, and campus health utilization; however, the findings are not statistically significant. There are distinctions in on campus health care usage when adjusting for undergraduate or graduate student status and health insurance literacy. Conclusion: The research findings offer many promising avenues for future work around Indigenous identity, affordability of healthcare, and importance of health literacy.

Keywords: Indigenous identity; perceived stress; colleges and universities; healthcare access; healthcare utilization

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MDPI and ACS Style

Carson, W.O.; Valenti, M.; Begay, K.; Carvajal, S.; Carroll, S.R.; Yuan, N.P.; Cordova-Marks, F.M. Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University. Int. J. Environ. Res. Public Health 2025, 22, 1409. https://doi.org/10.3390/ijerph22091409

AMA Style

Carson WO, Valenti M, Begay K, Carvajal S, Carroll SR, Yuan NP, Cordova-Marks FM. Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University. International Journal of Environmental Research and Public Health. 2025; 22(9):1409. https://doi.org/10.3390/ijerph22091409

Chicago/Turabian Style

Carson, William O., Michelle Valenti, Kendrick Begay, Scott Carvajal, Stephanie Russo Carroll, Nicole P. Yuan, and Felina M. Cordova-Marks. 2025. "Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University" International Journal of Environmental Research and Public Health 22, no. 9: 1409. https://doi.org/10.3390/ijerph22091409

APA Style

Carson, W. O., Valenti, M., Begay, K., Carvajal, S., Carroll, S. R., Yuan, N. P., & Cordova-Marks, F. M. (2025). Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University. International Journal of Environmental Research and Public Health, 22(9), 1409. https://doi.org/10.3390/ijerph22091409

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Evaluating Indigenous Identity and Stress as Potential Barriers to Accessing On-Campus Healthcare for Indigenous Students at a Large Southwestern University

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