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Unger ES, McConnell M, Austin SB, Rosenthal MB, Agénor M. Examining the Association Between Affordable Care Act Medicaid Expansion and Sexually Transmitted Infection Testing Among U.S. Women. Womens Health Issues 2024; 34:14-25. [PMID: 37945444 DOI: 10.1016/j.whi.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Sexually transmitted infection (STI) rates are rising among women in the United States, increasing the importance of routine STI testing. Beginning in 2014, some states expanded Medicaid under the Affordable Care Act, providing health coverage to most individuals in and near poverty. Here, we investigate whether Medicaid expansion changed rates of STI testing among U.S. women. METHODS We analyzed nationally representative 2011-2017 National Survey of Family Growth data from U.S. women ages 15-44. Using difference-in-differences analysis, we assessed whether Medicaid expansion was associated with within-state changes in the prevalence of STI testing in the past 12 months, among women overall and by race/ethnicity and sexual orientation, during each year following Medicaid expansion. Models were adjusted for individual- and state-level demographic and socioeconomic factors. RESULTS Our sample included 14,196 U.S. women. Medicaid expansion was associated with higher STI testing rates, which increased over time. By 3 years post-expansion, expansion states had increased STI testing by 12.7 percentage points more than nonexpansion states (95% confidence interval [CI] [2.5, 23.0], p = .016). This association was imprecisely estimated within racial/ethnic and sexual orientation subgroups, but trended strongest among white, Latina, and heterosexual women, followed by Black and bisexual women (who tested more often at baseline). CONCLUSIONS Medicaid expansion is associated with increased STI testing among U.S. women; these benefits grew over time but varied by both race/ethnicity and sexual orientation. State governments that fail to expand Medicaid may harm their residents' health by allowing more spread of STIs.
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Affiliation(s)
- Emily S Unger
- Cambridge Health Alliance Family Medicine Residency, Malden, Massachusetts.
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Harvard T.H. Chan School of Public Health/Boston Children's Hospital, Boston, Massachusetts
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Madina Agénor
- Department of Behavioral and Social Sciences and Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
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Magarati M, Chambers RS, Yenokyan G, Rosenstock S, Walls M, Slimp A, Larzelere F, Lee A, Pinal L, Tingey L. Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use. Front Public Health 2022; 10:829539. [PMID: 36033733 PMCID: PMC9411734 DOI: 10.3389/fpubh.2022.829539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/02/2022] [Indexed: 01/21/2023] Open
Abstract
Objective The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults. Methods We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers. Results A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38). Conclusion Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.
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Affiliation(s)
- Maya Magarati
- Seven Directions, A Center for Indigenous Public Health, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States,*Correspondence: Maya Magarati
| | - Rachel Strom Chambers
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Baltimore, MD, United States
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Melissa Walls
- Department of International Health, John Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, United States
| | - Anna Slimp
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Angelita Lee
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Laura Pinal
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
| | - Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, Whiteriver, AZ, United States
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Borgogna JLC, Anastario M, Firemoon P, Rink E, Ricker A, Ravel J, Brotman RM, Yeoman CJ. Vaginal microbiota of American Indian women and associations with measures of psychosocial stress. PLoS One 2021; 16:e0260813. [PMID: 34890405 PMCID: PMC8664215 DOI: 10.1371/journal.pone.0260813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022] Open
Abstract
Molecular-bacterial vaginosis (BV) is characterized by low levels of vaginal Lactobacillus species and is associated with higher risk of sexually transmitted infections (STI). Perceived psychosocial stress is associated with increased severity and persistence of infections, including STIs. American Indians have the highest rates of stress and high rates of STIs. The prevalence of molecular-BV among American Indian women is unknown. We sought to evaluate measures of psychosocial stress, such as historic loss (a multigenerational factor involving slavery, forced removal from one's land, legally ratified race-based segregation, and contemporary discrimination) and their association with the vaginal microbiota and specific metabolites associated with BV, in 70 Northwestern Plains American Indian women. Demographics, perceived psychosocial stressors, sexual practices, and known BV risk factors were assessed using a modified version of the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project survey. Self-collected mid-vaginal swabs were profiled for bacterial composition by 16S rRNA gene amplicon sequencing and metabolites quantified by targeted liquid-chromatography mass spectrometry. Sixty-six percent of the participants were classified as having molecular-BV, with the rest being either dominated by L. crispatus (10%) or L. iners (24%). High levels of lifetime trauma were associated with higher odds of having molecular-BV (adjusted Odds Ratio (aOR): 2.5, 95% Credible Interval (CrI): 1.1-5.3). Measures of psychosocial stress, including historic loss and historic loss associated symptoms, were significantly associated with lifestyle and behavioral practices. Higher scores of lifetime trauma were associated with increased concentrations of spermine (aFC: 3.3, 95% CrI: 1.2-9.2). Historic loss associated symptoms and biogenic amines were the major correlates of molecular-BV. Historical loss associated symptoms and lifetime trauma are potentially important underlying factors associated with BV.
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Affiliation(s)
- Joanna-Lynn C. Borgogna
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana, United States of America
- Department of Animal and Range Sciences, Montana State University, Bozeman, Montana, United States of America
| | - Michael Anastario
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, Florida, United States of America
| | - Paula Firemoon
- Fort Peck Community College, Poplar, Montana, United States of America
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, Montana, United States of America
| | - Adriann Ricker
- School of Public Health–Center for American Indian Health and School of Nursing, John Hopkins University, Baltimore, Maryland, United States of America
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Rebecca M. Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Carl J. Yeoman
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana, United States of America
- Department of Animal and Range Sciences, Montana State University, Bozeman, Montana, United States of America
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Impacts of the respecting the circle of life teen pregnancy prevention program on risk and protective factors for early substance use among native American youth. Drug Alcohol Depend 2021; 228:109024. [PMID: 34536716 DOI: 10.1016/j.drugalcdep.2021.109024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Early substance use disproportionately impacts Native American (Native) youth and increases their risk for future abuse and dependence. The literature urges for interventions to move beyond focusing on single risk behaviors (e.g. substance use) and instead have capacity to improve health risk behaviors co-occuring during adolescence, particularly among Native populations for whom few evidence-based interventions (EBI) exist. We evaluated the effectiveness of the Respecting the Circle of Life program (RCL) on risk and protective factors for early substance use. RCL is a culturally tailored EBI shown to improve sexual health outcomes among Native youth. METHODS We conducted secondary analyses of data collected through a community-based randomized controlled trial of RCL evaluated among Native youth (ages 11-19) residing on a rural reservation between 2015-2020 (N = 534, 47.4 % male). We used linear regression, controlling for baseline age and sex, to test between study group differences in outcomes at 3-, 9-, and 12-month post-intervention. Models were stratified by sex and age (11-12, 13-14, and 15+ years of age) to examine differences within these subgroups. RESULTS Youth receiving RCL reported lower intention to use substances through 12-months follow-up (p = 0.006). Statistically significant improvements were also observed across peer, parent, and sexual partner risk and protective factors to delay substance use initiation, with notable differences among boys and participants ages 13-14. CONCLUSIONS RCL is a primary prevention, skills-based program effective in preventing risks for substance use. This evaluation underscores the value in developing programs that influence concurrent adolescent risk behaviors, especially for Native communities who endure multiple health disparities.
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Tingey L, Chambers R, Patel H, Littlepage S, Lee S, Lee A, Susan D, Melgar L, Slimp A, Rosenstock S. Prevention of Sexually Transmitted Diseases and Pregnancy Prevention Among Native American Youths: A Randomized Controlled Trial, 2016-2018. Am J Public Health 2021; 111:1874-1884. [PMID: 34529503 PMCID: PMC8561210 DOI: 10.2105/ajph.2021.306447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the efficacy of the Respecting the Circle of Life program (RCL) among Native American youths 11 to 19 years of age residing in a rural reservation community in the southwestern United States. Methods. Between 2016 and 2018, we conducted a randomized controlled trial of the RCL program with 534 Native youths. Participants completed assessments at baseline and 9 and 12 months after the intervention. We conducted intention-to-treat analyses based on study group randomization. Results. At 9 months, intervention participants had significantly better condom use self-efficacy (P < .001), higher intentions to use condoms (P = .024) and abstain from sex (P = .008), and better contraceptive use self-efficacy (P < .001) than control participants, as well as better condom use (P = .032) and contraceptive use (P = .002) negotiation skills. At 12 months, intervention participants had significantly better sexual and reproductive health knowledge (P = .021), condom use self-efficacy (P < .001), contraceptive use self-efficacy (P < .001), and contraceptive use negotiation skills (P = .004) than control participants. Intervention participants reported significantly more communication with their parents about sexual and reproductive health than control participants at both 9 and 12 months (P = .042 and P = .001, respectively). Conclusions. The RCL program has a significant impact on key factors associated with pregnancy prevention among Native youths and should be used as an adolescent pregnancy prevention strategy. Trial Registration. Clinical Trials.gov identifier: NCT02904629. (Am J Public Health. 2021;111(10): 1874-1884. https://doi.org/10.2105/AJPH.2021.306447).
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Affiliation(s)
- Lauren Tingey
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Rachel Chambers
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Hima Patel
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Shea Littlepage
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Shauntel Lee
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Angelita Lee
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Davette Susan
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Laura Melgar
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Anna Slimp
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
| | - Summer Rosenstock
- The authors are with the Bloomberg School of Public Health, Center for American Indian Health, Johns Hopkins University, Baltimore, MD
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Sacca L, Craig Rushing S, Markham C, Shegog R, Peskin M, Hernandez B, Gaston A, Singer M, Trevino N, Correa CC, Jessen C, Williamson J, Thomas J. Assessment of the Reach, Usability, and Perceived Impact of " Talking Is Power": A Parental Sexual Health Text-Messaging Service and Web-Based Resource to Empower Sensitive Conversations with American Indian and Alaska Native Teens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9126. [PMID: 34501715 PMCID: PMC8431363 DOI: 10.3390/ijerph18179126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early sexual debut among American Indian and Alaska Native (AI/AN) adolescents has been associated with an increased risk of teenage pregnancies and sexually transmitted infections, along with an increased risk of having multiple lifetime sexual partners, and engaging in greater frequency of sex, substance abuse, and lack of condom use. A major protective factor against early sexual debut among AI/AN youth is the familial system. Interventions aiming to improve parent-child communication and parental warmth toward adolescent sexual health topics were reported to contribute to positive youth sexual health outcomes, specifically among minority youth. Healthy Native Youth thus developed the Talking is Power text-messaging service to guide parents and caring adults on how to initiate sensitive topics with youth and how to support them in making informed decisions regarding sex and healthy relationships. METHODS Descriptive statistics were used to demonstrate website analytics and reach per views and time spent on each page, and for displaying participants' responses to the questions on the usability of the Talking is Power text-messaging series. To assess the perceived impact of the series, the differences in mean percentage scores of the question assessing parental comfort in engaging in sexual health topics with youth between pre- and post-intervention were calculated using two-sample t-tests of equal variances. Descriptive content analysis was adopted to highlight emerging themes from open-ended items. RESULTS When looking at reach, 862 entrances were recorded during the specified time period (5.8% of total entrances to HNY website), while the bounce rate was set at 73.1% (22.6% greater than the industry average), and the exit rate was 54.3% (15.2% greater than the industry average). Series usability was highly ranked on the 5-Likert scale in terms of signing up for a similar series on a different topic, quality of images, texts, and links, relating to prompts, and change in sparking sensitive conversations with youth. High likelihood of recommending the series to a friend or colleague was also reported by participants (0-10). No significant difference in parental comfort levels was reported (p = 0.78 > 0.05). Main themes provided suggestions for improving the series mode of delivery, while others included positive feedback about the material, with the possibility of expanding the series to other adolescent health topics. CONCLUSION Lessons learned during the design, dissemination, and evaluation of the resource's usability, reach, and perceived impact may be of interest to other Indigenous communities who are in the process of adapting and/or implementing similar approaches.
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Affiliation(s)
- Lea Sacca
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Stephanie Craig Rushing
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Christine Markham
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Melissa Peskin
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Belinda Hernandez
- School of Public Health, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Nicole Trevino
- Northwest Portland Area Indian Health Board, Portland, OR 97201, USA; (A.G.); (M.S.); (N.T.)
| | - Chrystial C. Correa
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (C.M.); (R.S.); (M.P.); (C.C.C.)
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jennifer Williamson
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA; (C.J.); (J.W.)
| | - Jerri Thomas
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ 85004, USA;
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Tingey L, Rosenstock S, Chambers R, Patel H, Melgar L, Slimp A, Lee A, Cwik M, Rompalo A, Gaydos C. Empowering our people: Predictors of retention in an STI risk reduction program among rural Native Americans with binge substance use. J Rural Health 2021; 38:323-335. [PMID: 34028866 DOI: 10.1111/jrh.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Substance use and sexual risk-taking have been shown to co-occur. Programs focused on sexually transmitted infections (STIs) reduction may benefit substance-using, particularly binge substance-using, adults. This is especially true for rural Native American communities who endure sexual and substance use disparities and have few STI risk reduction programs. This study explores factors predicting retention in an STI risk reduction program among rural Native adults engaged in binge substance use. METHODS We analyzed data from 150 Native adults ages 18-55 participating in an evaluation of "EMPWR," a 2-session STI risk reduction program in a rural, reservation-based community. Multivariate logistic regression models were used to estimate associations between independent variables and program completion across demographics, sexual behaviors, substance use behaviors, mental health, recent health care utilization, and perceived enculturation and discrimination. FINDINGS The sample was 49.2% (n = 59) female with a mean age of 33.61 years (SD = 8.25). Twenty-six completed only the first EMPWR session, 94 completed both EMPWR sessions, and 30 were randomized but completed 0 sessions. Being married/cohabiting (adjusted odds ratio [AOR] = 6.40, P = .0063) and living with an older generation (AOR = 4.86, P = .0058) were significantly associated with higher odds of completing EMPWR. CONCLUSIONS Findings provide insight on factors driving retention of Natives with recent binge substance use in STI risk reduction programming. An important contribution to Native health literature is that living with an older generation positively predicted EMPWR program completion, suggesting that STI risk reduction programs should harness the strength of families to ensure program attendance and optimize impacts in rural reservation contexts.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel Chambers
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hima Patel
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Melgar
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Slimp
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angelita Lee
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Cwik
- Johns Hopkins Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Rompalo
- Center for the Development of Point of Care Tests for Sexually Transmitted Diseases, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Charlotte Gaydos
- Center for Global Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Logie CH, Lys CL, Dias L, Schott N, Zouboules MR, MacNeill N, Mackay K. "Automatic assumption of your gender, sexuality and sexual practices is also discrimination": Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1204-1213. [PMID: 30989767 DOI: 10.1111/hsc.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
Sexual and mental health disparities are reported in Arctic Canada as in other Arctic regions that experience shared challenges of insufficient healthcare resources, limited transportation, and a scarcity of healthcare research. Lesbian, gay, bisexual, transgender, and queer persons (LGBTQ+) report sexual and mental health disparities in comparison with their heterosexual and cisgender counterparts, and these disparities may be exacerbated in rural versus urban settings. Yet limited research has explored sexual healthcare experiences among LGBTQ+ persons in the Arctic who are at the juncture of Arctic and LGBTQ+ health disparities. We conducted a qualitative study from May 2015 to October 2015 with LGBTQ+ persons in the Northwest Territories, Canada that involved in-depth individual interviews with LGBTQ+ youth (n = 16), LGBTQ+ adults (n = 21), and key informants (e.g. coaches, teachers, nurses, social workers, and healthcare providers) (n = 14). We conducted thematic analysis, a theoretically flexible approach that integrates deductive and inductive approaches, to identify and map themes in the data. Findings reveal geographical, social, and healthcare factors converge to shape healthcare access. Specifically, the interplay between heterosexism and cisnormativity, intersectional forms of stigma, and place limited LGBTQ+ persons' sexual healthcare access and produced negative experiences in sexual healthcare. Limited healthcare facilities in small communities resulted in confidentiality concerns. Heteronormativity and cisnormativity constrained the ability to access appropriate sexual healthcare. LGBTQ+ persons experienced LGBTQ+, HIV, and sexually transmitted infections stigma in healthcare. Participants also discussed healthcare provider recommendations to better serve LGBTQ+ persons: non-judgment, knowledge of LGBTQ+ health issues, and gender inclusivity. Findings can inform multi-level strategies to reduce intersecting stigma in communities and healthcare, transform healthcare education, and build LGBTQ+ persons' healthcare navigation skills.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Candice L Lys
- Fostering Open eXpression Among Youth (FOXY), Yellowknife, NT, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lisa Dias
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nicole Schott
- Ontario Institute for Studies in Education (OISE), University of Toronto, Toronto, ON, Canada
| | | | - Nancy MacNeill
- Fostering Open eXpression Among Youth (FOXY), Yellowknife, NT, Canada
| | - Kayley Mackay
- Fostering Open eXpression Among Youth (FOXY), Yellowknife, NT, Canada
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Chambers RS, Rosenstock S, Lee A, Goklish N, Larzelere F, Tingey L. Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory. Front Public Health 2018; 6:318. [PMID: 30483489 PMCID: PMC6240587 DOI: 10.3389/fpubh.2018.00318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention. Methods: We analyzed baseline data from the sample of 267 AIs, ages 13-19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience. Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth. Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.
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Affiliation(s)
- Rachel Strom Chambers
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Summer Rosenstock
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Angie Lee
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Novalene Goklish
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Francene Larzelere
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Lauren Tingey
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
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Tingey L, Chambers R, Rosenstock S, Larzelere F, Goklish N, Lee A, Rompalo A. Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural, Reservation-Based American Indian Youth. J Prim Prev 2018; 39:401-420. [PMID: 30046947 DOI: 10.1007/s10935-018-0517-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13-19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD = 1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.
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Affiliation(s)
- Lauren Tingey
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA.
| | - Rachel Chambers
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Summer Rosenstock
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Francene Larzelere
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Angelita Lee
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
| | - Anne Rompalo
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, John Hopkins University, 415 N. Washington St., 4th Floor, Baltimore, MD, 21231, USA
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King Bowes K, Burrus BB, Axelson S, Garrido M, Kimbriel A, Abramson L, Gorman G, Dancer A, White T, Beaudry PJ. Reducing Disparities in Adolescent Pregnancy Among US Tribal Youths. Am J Public Health 2018; 108:S23-S24. [PMID: 29443558 PMCID: PMC5813783 DOI: 10.2105/ajph.2017.304267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Kendra King Bowes
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Barri B Burrus
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Sarah Axelson
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Milagros Garrido
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Adriana Kimbriel
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Lisa Abramson
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Gwenda Gorman
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Angela Dancer
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - Terrill White
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
| | - P J Beaudry
- Kendra King Bowes is with Native American Management Services, Inc., Reston, VA. Barri B. Burrus is with RTI International, Research Triangle Park, NC. Sarah Axelson is with the Family & Youth Services Bureau, Washington, DC. Milagros Garrido is with Healthy Teen Network, Baltimore, MD. Adriana Kimbriel is with the California Rural Indian Health Board, Sacramento, CA. Lisa Abramson is with the Inter-Tribal Council of Michigan, Sault Ste. Marie. Gwenda Gorman is with the Inter-Tribal Council of Arizona, Phoenix. Angela Dancer is with the Choctaw Nation of Oklahoma, Hugo. Terrill White is from Tulsa, OK. PJ Beaudry is with the Great Plains Tribal Chairmen's Health Board, Rapid City, SD. Barri B. Burrus is also a Guest Editor for this supplement issue
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Gesink D, Whiskeyjack L, Suntjens T, Mihic A, McGilvery P. Abuse of power in relationships and sexual health. CHILD ABUSE & NEGLECT 2016; 58:12-23. [PMID: 27337692 DOI: 10.1016/j.chiabu.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 06/06/2023]
Abstract
STI rates are high for First Nations in Canada and the United States. Our objective was to understand the context, issues, and beliefs around high STI rates from a nêhiyaw (Cree) perspective. Twenty-two in-depth interviews were conducted with 25 community participants between March 1, 2011 and May 15, 2011. Interviews were conducted by community researchers and grounded in the Cree values of relationship, sharing, personal agency and relational accountability. A diverse purposive snowball sample of community members were asked why they thought STI rates were high for the community. The remainder of the interview was unstructured, and supported by the interviewer through probes and sharing in a conversational style. Modified grounded theory was used to analyze the narratives and develop a theory. The main finding from the interviews was that abuse of power in relationships causes physical, mental, emotional and spiritual wounds that disrupt the medicine wheel. Wounded individuals seek medicine to stop suffering and find healing. Many numb suffering by accessing temporary medicines (sex, drugs and alcohol) or permanent medicines (suicide). These medicines increase the risk of STIs. Some seek healing by participating in ceremony and restoring relationships with self, others, Spirit/religion, traditional knowledge and traditional teachings. These medicines decrease the risk of STIs. Younger female participants explained how casual relationships are safer than committed monogamous relationships. Resolving abuse of power in relationships should lead to improvements in STI rates and sexual health.
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Affiliation(s)
- Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College St., 6th Floor, Toronto, Ontario M5T 3M7, Canada.
| | - Lana Whiskeyjack
- Blue Quills First Nations College, Box 279, St. Paul, Alberta T0A 3A0, Canada.
| | - Terri Suntjens
- Blue Quills First Nations College, Box 279, St. Paul, Alberta T0A 3A0, Canada.
| | - Alanna Mihic
- University of Toronto, 155 College St., Toronto, Ontario M5T 3M7, Canada.
| | - Priscilla McGilvery
- Saddle Lake Health Center, P.O. Box 160, Saddle Lake, Alberta T0A 3T0, Canada.
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Walker FJ, Llata E, Doshani M, Taylor MM, Bertolli J, Weinstock HS, Hall HI. HIV, Chlamydia, Gonorrhea, and Primary and Secondary Syphilis among American Indians and Alaska Natives Within Indian Health Service Areas in the United States, 2007-2010. J Community Health 2016; 40:484-92. [PMID: 25371109 DOI: 10.1007/s10900-014-9961-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
National rates from human immunodeficiency virus (HIV) and sexually transmitted disease (STD) surveillance may not effectively convey the impact of HIV and STDs on American Indian/Alaska Native (AI/AN) communities. Instead, we compared average annual diagnosis rates per 100,000 population of HIV, chlamydia (CT), gonorrhea (GC), and primary and secondary (P&S) syphilis, from 2007 to 2010, among AI/AN aged ≥ 13 years residing in 625 counties in the 12 Indian Health Service Areas, all AI/AN, and all races/ethnicities to address this gap. AI/AN comprised persons reported as AI/AN only, with or without Hispanic ethnicity. Out of 12 IHS Areas, 10 had higher case rates for CT, 3 for GC, and 4 for P&S syphilis compared to rates for all races/ethnicities. Eight Areas had higher HIV diagnosis rates than for all AI/AN, but HIV rates for all IHS Areas were lower than national rates for all races/ethnicities. Two IHS Areas ranking highest in rates of CT and GC and four Areas with highest P&S syphilis also had high HIV rates. STD and HIV rates among AI/AN were greater in certain IHS Areas than expected from observing national rates for AI/AN. Integrated surveillance of overlapping trends in STDs and HIV may be useful in guiding prevention efforts for AI/AN populations.
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Affiliation(s)
- Frances J Walker
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Gaines TL, Caldwell JT, Ford CL, Mulatu MS, Godette DC. Relationship between a Centers for Disease Control and Prevention expanded HIV testing initiative and past-year testing by race/ethnicity: a multilevel analysis of the Behavioral Risk Factor Surveillance System. AIDS Care 2016; 28:554-60. [PMID: 27045327 PMCID: PMC4868383 DOI: 10.1080/09540121.2015.1131968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The Centers for Disease Control and Prevention's (CDC) expanded testing initiative (ETI) aims to bolster HIV testing among populations disproportionately affected by the HIV epidemic by providing additional funding to health departments serving these communities. ETI prioritizes testing in clinical settings; therefore, we examined the relationship between state-level ETI participation and past-year HIV testing among a racially/ethnically diverse sample of adult respondents to the 2012 Behavioral Risk Factor Surveillance System who accessed health services within the 12 months prior to being interviewed. Controlling for individual- and state-level characteristics in a multilevel logistic regression model, ETI participation was independently and positively associated with past-year testing, but this association varied by race/ethnicity. Hispanics had higher odds (adjusted odds ratio [AOR]: 1.49; 95% CI: 1.11-2.02) and American Indian/Alaska Natives had lower odds (AOR: 0.66; 95% CI: 0.43-0.99) of testing if they resided in states with (vs. without) ETI participation. State-level ETI participation did not significantly alter past-year testing among other racial/ethnic groups. Prioritizing public health resources in states most affected by HIV can improve testing patterns, but other mechanisms likely influence which racial/ethnic groups undergo testing.
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Affiliation(s)
- Tommi L. Gaines
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Julia T. Caldwell
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Chandra L. Ford
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Dionne C. Godette
- Division of Epidemiology and Prevention Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA
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Negin J, Aspin C, Gadsden T, Reading C. HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav 2015; 19:1720-34. [PMID: 25731659 PMCID: PMC4551545 DOI: 10.1007/s10461-015-1023-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
From the early days of the HIV epidemic, Indigenous peoples were identified as a population group that experiences social and economic determinants-including colonialism and racism-that increase exposure to HIV. There are now substantial disparities in HIV rates between Indigenous and non-Indigenous peoples in some countries. We conducted a comprehensive literature review to assess the evidence on HIV-related behaviors and determinants in four countries-Australia, Canada, New Zealand and the United States-in which Indigenous peoples share important features of colonization and marginalization. We identified 107 articles over more than 20 years. The review highlights the determinants of HIV-related behaviors including domestic violence, stigma and discrimination, and injecting drug use. Many of the factors associated with HIV risk also contribute to mistrust of health services, which in turn contributes to poor HIV and health outcomes among Indigenous peoples.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia,
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Raglan GB, Lannon SM, Jones KM, Schulkin J. Racial and Ethnic Disparities in Preterm Birth Among American Indian and Alaska Native Women. Matern Child Health J 2015; 20:16-24. [DOI: 10.1007/s10995-015-1803-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Ravello L, Folkema A, Tulloch S, Taylor M, Reilley B, Hoover K, Holman R, Creanga A. Ectopic pregnancy among American Indian and Alaska Native women, 2002-2009. Matern Child Health J 2015; 19:733-8. [PMID: 25023759 PMCID: PMC4303537 DOI: 10.1007/s10995-014-1558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.
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Affiliation(s)
- Lori de Ravello
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS F-74, Atlanta, GA 30341, USA
| | - Arianne Folkema
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS A-30, Atlanta, GA 30333, USA
| | - Scott Tulloch
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-45, Atlanta, GA 30333, USA
| | - Melanie Taylor
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, c/o ADHS, 1845 E. Roosevelt St., Phoenix, AZ 85006, USA
| | - Brigg Reilley
- HIV/AIDS Prevention Program, Division of Epidemiology and Disease Prevention, Indian Health Service, 5300 Homestead Rd NE, Albuquerque, NM 87110, USA
| | - Karen Hoover
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE MS E-45, Atlanta, GA 30333, USA
| | - Robert Holman
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS A-30, Atlanta, GA 30333, USA
| | - Andreea Creanga
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS F-74, Atlanta, GA 30341, USA
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Pearson CR, Kaysen D, Belcourt A, Stappenbeck CA, Zhou C, Smartlowit-Briggs L, Whitefoot P. Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska Native women. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2015; 22:1-20. [PMID: 26425863 PMCID: PMC4603289 DOI: 10.5820/aian.2203.2015.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.
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Pearson CR, Cassels S. Place and sexual partnership transition among young American Indian and Alaska native women. AIDS Behav 2014; 18:1443-53. [PMID: 24276791 DOI: 10.1007/s10461-013-0667-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple challenges expose American Indian and Alaska Native (AIAN) women to high-risk sexual partnerships and increased risk for HIV/STI. Using a unique sample of sexually-active young AIAN women (n = 129), we examined characteristics of last three partners and whether transitional partnerships were associated with different risk profiles, including where partners met, lived, and had sex. Respondents were more likely to have met their previous or current secondary partner (P2) at a friend's or family setting (versus work or social setting) (AOR = 3.92; 95 % CI 1.31, 11.70). Condom use was less likely when meeting a partner at friend's or family settings (AOR = 0.17; 95 % CI 0.05, 0.59). Sexual intercourse with P2 (compared to P1) usually took place in "riskier" settings such as a car, bar, or outside (AOR = 4.15; 95 % CI 1.59, 10.68). Perceived "safe" places, e.g., friend's or family's house, were identified with risky behaviors; thus, homogeneous messaging campaigns may promote a false sense of safety.
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Affiliation(s)
- Cynthia R Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Box 354900, Seattle, WA, 98105-6299, USA,
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Hepatitis C virus in American Indian/Alaskan Native and Aboriginal peoples of North America. Viruses 2013; 4:3912-31. [PMID: 23342378 PMCID: PMC3528296 DOI: 10.3390/v4123912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liver diseases, such as hepatitis C virus (HCV), are “broken spirit” diseases. The prevalence of HCV infection for American Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals varies; nonetheless, incidence rates of newly diagnosed HCV infection are typically higher relative to non-indigenous people. For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV can reflect that of the general population: predominately male, a history of injection drug use, in midlife years, with a connection with urban centers. However, the face of the indigenous HCV infected individual is becoming increasingly female and younger compared to non-indigenous counterparts. Epidemiology studies indicate that more effective clearance of acute HCV infection can occur for select Aboriginal populations, a phenomenon which may be linked to unique immune characteristics. For individuals progressing to chronic HCV infection treatment outcomes are comparable to other racial cohorts. Disease progression, however, is propelled by elevated rates of co-morbidities including type 2 diabetes and alcohol use, along with human immunodeficiency virus (HIV) co-infection relative to non-indigenous patients. Historical and personal trauma has a major role in the participation of high risk behaviors and associated diseases. Although emerging treatments provide hope, combating HCV related morbidity and mortality will require interventions that address the etiology of broken spirit diseases.
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Pearson CR, Walters KL, Simoni JM, Beltran R, Nelson KM. A cautionary tale: risk reduction strategies among urban American Indian/Alaska Native men who have sex with men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2013; 25:25-37. [PMID: 23387949 PMCID: PMC3951888 DOI: 10.1521/aeap.2013.25.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.
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Affiliation(s)
- Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA 98105, USA.
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'I've had unsafe sex so many times why bother being safe now?': the role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. Ann Behav Med 2012; 42:370-80. [PMID: 21887585 DOI: 10.1007/s12160-011-9302-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. PURPOSE This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. METHODS AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. RESULTS Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. CONCLUSIONS Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.
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Abstract
BACKGROUND In a largely rural region of North Carolina during 1998-2002, outbreaks of heterosexually transmitted syphilis occurred, tied to crack cocaine use and exchange of sex for drugs and money. Sexual partnership mixing patterns are an important characteristic of sexual networks that relate to transmission dynamics of sexually transmitted infections (STIs). METHODS Using contact tracing data collected by disease intervention specialists, we estimated Newman assortativity coefficients and compared values in counties experiencing syphilis outbreaks to nonoutbreak counties, with respect to race/ethnicity, race/ethnicity and age, and the cases' number of social/sexual contacts, infected contacts, sex partners, and infected sex partners, and syphilis disease stage (primary, secondary, early latent). RESULTS Individuals in the outbreak counties had more contacts and mixing by the number of sex partners was disassortative in outbreak counties and assortative nonoutbreak counties. Although mixing by syphilis disease stage was minimally assortative in outbreak counties, it was disassortative in nonoutbreak areas. Partnerships were relatively discordant by age, especially among older white men, who often chose considerably younger female partners. CONCLUSIONS Whether assortative mixing exacerbates or attenuates the reach of STIs into different populations depends on the characteristic/attribute and epidemiologic phase. Examination of sexual partnership characteristics and mixing patterns offers insights into the growth of STI outbreaks that complement other research methods.
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Gryczynski J, Johnson JL. Challenges in public health research with American Indians and other small ethnocultural minority populations. Subst Use Misuse 2011; 46:1363-71. [PMID: 21810071 DOI: 10.3109/10826084.2011.592427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland 21201, USA.
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Devries KM, Free CJ. Boyfriends and booty calls: sexual partnership patterns among Canadian Aboriginal young people. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2011; 102:13-17. [PMID: 21485961 PMCID: PMC6974215 DOI: 10.1007/bf03404871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 08/20/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Sexual partnership patterns, forced sex, and condom non-use can contribute to STI risk, but little is known about these patterns among Aboriginal young people despite elevated STI risk in this group. We describe sexual relationship and condom use patterns among Canadian Aboriginal young people, and how these patterns relate to the socio-structural context as experienced by young people. METHODS We use data from in-depth individual interviews conducted in 2004 with 22 young people who reported ever having sex and who self-identified as Aboriginal in British Columbia, Canada. A thematic analysis is presented. RESULTS Young people described a range of partnership patterns, including 'on-off' relationships which could have high rates of partner turnover but could sometimes be viewed as acceptable contexts for pregnancy, precluding condom use. Contextual elements beyond individual control appeared to contribute to these patterns. Migration between geographic locations was linked with risky partnership patterns, especially if it was linked with family instability or substance use problems. CONCLUSION Sexual health interventions for this group must address partnership patterns in addition to promoting condom use. Survey research into 'migration' as a risk factor for STI transmission should consider reasons for migration. Interventions that address both individual level behaviour and the contextual elements that shape behaviour should be developed and tested.
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Affiliation(s)
- Karen M Devries
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Winscott M, Taylor M, Kenney K. Sexually transmitted diseases among American Indians in Arizona: an important public health disparity. Public Health Rep 2010; 125 Suppl 4:51-60. [PMID: 20626193 DOI: 10.1177/00333549101250s409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We conducted an analysis of rates, geographic distribution, and time to treatment of chlamydia, gonorrhea, and early syphilis (ES) among Arizona American Indians (AIs) to address racial disparities affecting this group. METHODS We used the Arizona Department of Health Services' sexually transmitted disease (STD) surveillance database to identify STD cases and calculate rates among AIs in Arizona from 2003 to 2007. We mapped AI ES cases reported during that time frame by reported resident ZIP code, calculated days elapsed from specimen collection to initial treatment, and compared rates and time to treatment for AIs with those of non-Hispanic white (NHW) individuals. RESULTS Annual Arizona AI STD rates for chlamydia, gonorrhea, and ES from 2003 to 2007 ranged from 2.7 to 7.8 times those of NHW people. During the same time period, the annual rates for all three STDs among adolescents aged 15 to 19 years were also higher among AIs and ranged from 2.0 to 14.8 times those of NHW individuals. The majority of cases for ES reported ZIP codes located in the northeastern and southern central portions of the state. The median time to treatment in AI populations was significantly longer than in NHW populations for chlamydia and gonorrhea, but not for ES. CONCLUSIONS High rates of STDs have been identified among AIs in certain regions of Arizona. Additionally, there are significant delays in treatment for gonorrhea and chlamydia. STD prevention and education programs that prioritize this health disparity and promote expeditious screening, diagnosis, and treatment are needed.
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Affiliation(s)
- Michelle Winscott
- Arizona Department of Health Services, Office of HIV, STD, and Hepatitis Services, 150 N. 18th Ave., Ste. 140, Phoenix, AZ 85007-3237, USA.
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Circle of life: rationale, design, and baseline results of an HIV prevention intervention among young American Indian adolescents of the Northern Plains. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2010; 11:101-12. [PMID: 19798577 DOI: 10.1007/s11121-009-0153-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In spite of significant disparities in sexual health outcomes for American Indian youth, no studies exist examining the effectiveness of HIV-prevention interventions. Circle of Life is an HIV-prevention intervention specifically developed for American Indian middle-school youth. We describe the rationale, methodology, and baseline results of a longitudinal randomized trial of Circle of Life conducted among American Indian youth aged 11-15 in a reservation community. The innovative design includes two pre-intervention waves to determine patterns of behavior prior to the intervention that might be associated with a differential impact of the intervention on sexual risk. We used one-way analysis of variance and chi-square tests to test for significant differences between randomized group assignment at each baseline wave and generalized estimating equations (GEE) to test significant differences in the rate of change in outcomes by group longitudinally. We present the collaborative and adaptive strategies for consenting, assenting, and data collection methodology in this community. Achieved response rates are comparable to other similar studies. Results from the two baseline waves indicate that few outcomes significantly varied by randomized intervention assignment. Ten percent of youth reported having had sex at Wave 1, rising to 15% at Wave 2. Among those who had had sex, the majority (>70%) reported using a condom at last sex. The project is well positioned to carry out the longitudinal assessments of the intervention to determine the overall impact of the Circle of Life and the differential impact by pre-intervention patterns of behavior across youth.
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Walters KL, Simoni JM. Decolonizing strategies for mentoring American Indians and Alaska Natives in HIV and mental health research. Am J Public Health 2009; 99 Suppl 1:S71-6. [PMID: 19246668 DOI: 10.2105/ajph.2008.136127] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
American Indian and Alaska Native (AIAN) scholars in the fields of mental health and HIV face formidable barriers to scientific success. These include justifiable mistrust of historically oppressive educational systems, educational disparities, role burdens within academe, the devaluation and marginalization of their research interests, and outright discrimination. Research partners can work to dismantle these barriers by embracing indigenous worldviews, engaging in collaborative research partnerships, building research capacity within universities and tribal communities, changing reward systems, and developing mentoring programs. At the individual level, aspiring AIAN scholars must build coalitions, reject internalized colonial messages, and utilize indigenous ethical frames. The creation of a cadre of AIAN researchers is crucial to improving the health of AIAN peoples.
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Affiliation(s)
- Karina L Walters
- Indigenous Wellness Research Institute, University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, USA.
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Chlamydia Positivity in American Indian/Alaska Native Women Screened in Family Planning Clinics, 1997–2004. Sex Transm Dis 2008; 35:753-7. [DOI: 10.1097/olq.0b013e31816d1f7d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shaw SY, Shah L, Jolly AM, Wylie JL. Identifying heterogeneity among injection drug users: a cluster analysis approach. Am J Public Health 2008; 98:1430-7. [PMID: 18556614 DOI: 10.2105/ajph.2007.120741] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used cluster analysis to subdivide a population of injection drug users and identify previously unknown behavioral heterogeneity within that population. METHODS We applied cluster analysis techniques to data collected in a cross-sectional survey of injection drug users in Winnipeg, Manitoba. The clustering variables we used were based on receptive syringe sharing, ethnicity, and types of drugs injected. RESULTS Seven clusters were identified for both male and female injection drug users. Some relationships previously revealed in our study setting, such as the known relationship between Talwin (pentazocine) and Ritalin (methylphenidate) use, injection in hotels, and hepatitis C virus prevalence, were confirmed through our cluster analysis approach. Also, relationships between drug use and infection risk not previously observed in our study setting were identified, an example being a cluster of female crystal methamphetamine users who exhibited high-risk behaviors but an absence or low prevalence of blood-borne pathogens. CONCLUSIONS Cluster analysis was useful in both confirming relationships previously identified and identifying new ones relevant to public health research and interventions.
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Affiliation(s)
- Souradet Y Shaw
- Cadham Provincial Laboratory, 750 William Ave, Winnipeg, Manitoba R3C3Y1, Canada
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Gesink Law D, Rink E, Mulvad G, Koch A. Sexual health and sexually transmitted infections in the North American Arctic. Emerg Infect Dis 2008; 14:4-9. [PMID: 18258070 PMCID: PMC2600166 DOI: 10.3201/eid1401.071112] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STI rates reported for the Arctic are much higher than those reported for their southern counterparts. Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and gonorrhea reported from 2003 through 2006 for Alaska, Canada, and Greenland. In 2006, Alaska reported high rates of chlamydial infection (715 cases/100,000 population) compared with the United States as a whole; northern Canada reported high rates of chlamydial infection (1,693 cases/100,000) and gonorrhea (247 cases/100,000) compared with southern Canada; and Greenland consistently reported the highest rates of chlamydial infection (5,543 cases/100,000) and gonorrhea (1,738 cases/100,000) in the Arctic. Rates were high for both men and women, although the highest incidence of infection was predominantly reported for young women in their early twenties. We propose that community-based participatory research is an appropriate approach to improve sexual health in Arctic communities.
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Affiliation(s)
- Dionne Gesink Law
- Department of Public Health Sciences, University of Toronto, 155 College Street, Toronto, Ontario, Canada.
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