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Skewes MC, Gonzalez VM, Gameon JA, Ricker A, Martell S, Reum M, Holder S. Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community. Clin Psychol Sci 2024; 12:253-269. [PMID: 38736431 PMCID: PMC11086671 DOI: 10.1177/21677026221141662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm and enhance Native identity, address culturally relevant risk factors, and build upon strengths. Results from a feasibility pilot study (N = 15) suggest that IRP is feasible to implement and acceptable to the community. Although there was insufficient statistical power to conduct hypothesis testing, there were changes between pretest and posttest scores in the expected directions. Future directions and limitations of this research are discussed.
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Affiliation(s)
| | | | - Julie A. Gameon
- Trauma and Resilience Center, The University of Texas Health Science Center at Houston
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Gonzalez VM, Stewart TJ. COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust. J Behav Med 2024; 47:123-134. [PMID: 37634151 DOI: 10.1007/s10865-023-00443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.
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Affiliation(s)
- Vivian M Gonzalez
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA.
| | - Tracy J Stewart
- Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 4464, 99508, USA
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Huang R, Xiao L, Zhu J, Cheng J, Torrie J, McHugh NGL, Auger N, Luo ZC. Population-based birth cohort study on diabetes in pregnancy and infant hospitalisations in Cree, other First Nations and non-Indigenous communities in Quebec. BMJ Open 2023; 13:e074518. [PMID: 38040430 PMCID: PMC10693854 DOI: 10.1136/bmjopen-2023-074518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES Diabetes in pregnancy, whether pre-gestational (chronic) or gestational (de novo hyperglycaemia), increases the risk of adverse birth outcomes. It is unclear whether gestational diabetes increases the risk of postnatal morbidity in infants. Cree First Nations in Quebec are at high risk for diabetes in pregnancy. We assessed whether pre-gestational or gestational diabetes may increase infant hospitalisation (an infant morbidity indicator) incidence, and whether this may be related to more frequent infant hospitalisations in Cree and other First Nations in Quebec. DESIGN Population-based birth cohort study through administrative health data linkage. SETTING AND PARTICIPANTS Singleton infants (≤1 year) born to mothers in Cree (n=5070), other First Nations (9910) and non-Indigenous (48 200) communities in rural Quebec. RESULTS Both diabetes in pregnancy and infant hospitalisation rates were much higher comparing Cree (23.7% and 29.0%) and other First Nations (12.4% and 34.1%) to non-Indigenous (5.9% and 15.5%) communities. Compared with non-diabetes, pre-gestational diabetes was associated with an increased risk of any infant hospitalisation to a greater extent in Cree and other First Nations (relative risk (RR) 1.56 (95% CI 1.28 to 1.91)) than non-Indigenous (RR 1.26 (1.15 to 1.39)) communities. Pre-gestational diabetes was associated with increased risks of infant hospitalisation due to diseases of multiple systems in all communities. There were no significant associations between gestational diabetes and risks of infant hospitalisation in all communities. The population attributable risk fraction of infant hospitalisations (overall) for pre-gestational diabetes was 6.2% in Cree, 1.6% in other First Nations and 0.3% in non-Indigenous communities. CONCLUSIONS The study is the first to demonstrate that pre-gestational diabetes increases the risk of infant hospitalisation overall and due to diseases of multiple systems, but gestational diabetes does not. High prevalence of pre-gestational diabetes may partly account for the excess infant hospitalisations in Cree and other First Nations communities in Quebec.
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Affiliation(s)
- Rong Huang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
| | - Lin Xiao
- Sainte-Justine Hospital Research Center, Montreal, Québec, Canada
| | - Jane Zhu
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Cheng
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Torrie
- Public-Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
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Hoover JH, Coker ES, Erdei E, Luo L, Begay D, MacKenzie D, Lewis J. Preterm Birth and Metal Mixture Exposure among Pregnant Women from the Navajo Birth Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127014. [PMID: 38109118 PMCID: PMC10727039 DOI: 10.1289/ehp10361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Preterm birth (PTB), defined as birth before 37 wk gestation, is associated with hypertension, diabetes, inadequate prenatal care, unemployment or poverty, and metal exposure. Indigenous individuals are more likely to have maternal risk factors associated with PTB compared with other populations in the United States; however, the role of environmental metals on PTB among pregnant Indigenous women remains uncertain. Previous research identified associations between PTB and individual metals, but there is limited investigation on metal mixtures and this birth outcome. OBJECTIVES We used a mixtures analysis framework to investigate the association between metal mixtures and PTB among pregnant Indigenous women from the Navajo Birth Cohort Study (NBCS). METHODS Maternal urine and blood samples were collected at the time of study enrollment and analyzed for metals by inductively coupled plasma dynamic reaction cell mass spectrometry. Bayesian Profile Regression was used to identify subgroups (clusters) of individuals with similar patterns of coexposure and to model association with PTB. RESULTS Results indicated six subgroups of maternal participants with distinct exposure profiles, including one group with low exposure to all metals and one group with total arsenic, cadmium, lead, and uranium concentrations exceeding representative concentrations calculated from the National Health and Nutrition Examination Survey (NHANES). Compared with the reference group (i.e., the lowest exposure subgroup), the subgroup with the highest overall exposure had a relative risk of PTB of 2.9 times (95% credible interval: 1.1, 6.1). Exposures in this subgroup were also higher overall than NHANES median values for women 14-45 years of age. DISCUSSION Given the wide range of exposures and elevated PTB risk for the most exposed subgroups in a relatively small study, follow-up investigation is recommended to evaluate associations between metal mixture profiles and other birth outcomes and to test hypothesized mechanisms of action for PTB and oxidative stress caused by environmental metals. https://doi.org/10.1289/EHP10361.
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Affiliation(s)
- Joseph H. Hoover
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Environmental Science, College of Agriculture, Life and Environmental Sciences, University of Arizona, Tucson, Arizona, USA
| | - Eric S. Coker
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Esther Erdei
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Li Luo
- Department of Internal Medicine and Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - David Begay
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Debra MacKenzie
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - NBCS Study Team
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Johnnye Lewis
- Community Environmental Health Program, College of Pharmacy, Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Sánchez-Barricarte JJ. Factors influencing the sex ratio at birth in the United States from a historical perspective. J Biosoc Sci 2023; 55:1015-1038. [PMID: 36645016 DOI: 10.1017/s0021932022000554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many of the studies on the sex ratio at birth (SRB) are based on a small number of cases over a short period of time. Taking a multivariate approach to a dataset consisting of nearly 199 million birth records in the United States from 1968 to 2019, we present a detailed analysis of several possible factors that might affect the sex ratio at birth (SRB) and its patterns of variation. We found that race/ethnicity is the variable with the strongest influence on this index. Parental age, birth order and solar radiation also have a bearing on the SRB, albeit only to a moderate degree. The historical evolution of the SRB among Black and American Indian and Alaska Native populations remains unexplained.
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Affiliation(s)
- Jesús J Sánchez-Barricarte
- Department of Social Analysis, Carlos III University of Madrid, Calle Madrid, 126; 28903 Getafe, Madrid, Spain
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Landis RK, Stein BD, Griffin BA, Saloner BK, Terplan M, Faherty LJ. Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012. J Addict Med 2023; 17:654-661. [PMID: 37934525 PMCID: PMC10759200 DOI: 10.1097/adm.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVES This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. METHODS We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. RESULTS Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). CONCLUSIONS Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.
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Affiliation(s)
- Rachel K Landis
- From the RAND Corporation, Arlington, VA (RKL, BAG); RAND Corporation, Pittsburgh, PA (BDS); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (BKS); Friends Research Institute, Baltimore, MD (MT); RAND Corporation, Boston, MA (LJF); and Department of Pediatrics, Maine Medical Center, Portland, ME (LJF)
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Markowski KL, White L, Harcey SR, Schmidt T, McEachern D, Habecker P, Wexler L. What Kinds of Support are Alaska Native Youth and Young Adults Reporting? An Examination of Types, Quantities, Sources, and Frequencies of Support. Health Promot Pract 2023; 24:863-872. [PMID: 36047453 PMCID: PMC10729876 DOI: 10.1177/15248399221115065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
American Indian and Alaska Native (AI/AN) youth, particularly males, experience disproportionately high rates of suicide compared to other young people in the United States. Therefore, enacting suicide prevention efforts for AI/AN youth is especially important. Since research shows that strengthening social, cultural, and emotional support can reduce suicide risk, many recent prevention efforts focus on these strategies. Yet, to reinforce and to extend the positive impact of these strategies for suicide risk reduction, we argue it is useful to identify baseline levels and other features of already-existing support. Toward this end, we describe the types (i.e., category), quantities (i.e., distribution and average number), sources (i.e., from whom), and frequencies (i.e., how often) of social support that AN young people report receiving, and we examine if these "support profiles" differ by age and sex. We use survey data from 165 ANs under age 30, collected as part of a participatory intervention study focused on Promoting Community Conversations About Research to End Suicide (PC CARES). We find that: 1) most ANs reported receiving nearly all supports, 2) compared with females, males reported receiving fewer supports on average, 3) family was the most selected support source, followed by close friends and service providers, and 4) family (e.g., parents, siblings, and grandparents) provided support regularly (i.e., monthly or more). Though our findings may suggest fruitful avenues for interventions targeted toward AN males, we discuss these findings in relation to the gendered nature of suicide prevention and assessment.
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Gao C, Sanchez KM, Lovinsky-Desir S. Structural and Social Determinants of Inequitable Environmental Exposures in the United States. Clin Chest Med 2023; 44:451-467. [PMID: 37517826 DOI: 10.1016/j.ccm.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.
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Affiliation(s)
- Courtney Gao
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Kimberly M Sanchez
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Stephanie Lovinsky-Desir
- Pulmonary Division, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY 10032, USA.
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Sinclair K, Nguyen CJ, Wetherill MS, Nelson K, Jackson AM, Taniguchi T, Jernigan VBB, Buchwald D. Native opportunities to stop hypertension: study protocol for a randomized controlled trial among urban American Indian and Alaska Native adults with hypertension. Front Public Health 2023; 11:1117824. [PMID: 37333529 PMCID: PMC10272533 DOI: 10.3389/fpubh.2023.1117824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction American Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics. Methods NOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly $30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake. Discussion NOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults. Clinical trials registration https://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313.
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Affiliation(s)
- Ka’imi Sinclair
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Cassandra J. Nguyen
- Nutrition Department at University of California, Davis, Davis, CA, United States
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Katie Nelson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | | | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
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Moore KR, Schroeder EB, Goodrich GK, Manson SM, Malone AS, Pieper LE, Son-Stone L, Johnson D, Steiner JF. Racial and Ethnic Equity in Care for Hypertension and Diabetes in an Urban Indian Health Organization. J Racial Ethn Health Disparities 2023; 10:1319-1328. [PMID: 35503165 PMCID: PMC9630166 DOI: 10.1007/s40615-022-01317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Approximately 70% of American Indian/Alaska Native (AI/AN) individuals reside in urban areas. Urban Indian Health Organizations (UIHOs) provide culturally engaged primary care for AI/AN patients and members of other racial and ethnic groups who have experienced disparities in diabetes and hypertension care, and are commonly affected by social and economic barriers to care. We assessed whether disparities were present between the racial and ethnic groups served by the largest UIHO in the USA. We developed retrospective cohorts of patients with hypertension or diabetes receiving primary care from this UIHO, measuring differences between AI/AN, Spanish-preferring Latinx, English-preferring Latinx, Black, and White patients in mean systolic blood pressure (SBP) and mean hemoglobin A1c (A1c) as primary outcomes. To assess processes of care, we also compared visit intensity, missed visits, and medication treatment intensity in regression models adjusted for sociodemographic and clinical characteristics. For hypertension (n = 2148), adjusted mean SBP ranged from 135.8 mm Hg among Whites to 141.3 mm Hg among Blacks (p = 0.06). For diabetes (n = 1211), adjusted A1c ranged from 7.7% among English-preferring Latinx to 8.7% among Blacks (p = 0.38). Care processes for both hypertension and diabetes varied across groups. No group consistently received lower-quality care. This UIHO provided care of comparable quality for hypertension and diabetes among urban-dwelling AI/ANs and members of other racial, ethnic, and language preference groups. Systematic assessments of care quality in UIHOs may help demonstrate the importance of their role in providing care and improve the quality of care.
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Affiliation(s)
- Kelly R Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, 13055 East 17th Avenue, Aurora, CO, 80045, USA.
| | | | - Glenn K Goodrich
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Allen S Malone
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Lisa E Pieper
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | | | - David Johnson
- First Nations Community HealthSource, Albuquerque, NM, USA
| | - John F Steiner
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Buckingham SL, Schroeder TU, Hutchinson JR. Knowing Who You Are (Becoming): Effects of a university-based elder-led cultural identity program on Alaska Native students' identity development, cultural strengths, sense of community, and behavioral health. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:389-401. [PMID: 37253202 PMCID: PMC10527247 DOI: 10.1037/ort0000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In part due to cultural loss and identity disruption over many generations from colonial and neocolonial forces, significant emotional/behavioral health disparities exist among Alaska Native (AN) people. Such forces are apparent in higher education, where many AN students feel othered and are more likely to withdraw without a degree than their nonnative counterparts. A strong cultural identity has been found to buffer psychosocial difficulties. The AN Cultural Identity Project (CIP) was developed from the best available scientific literature, local data from AN students, and traditional wisdom from Elders to support cultural identity development. This 8-week Elder-led program incorporated storytelling, experiential learning, connection, exploration, and sharing of identity and cultural strengths to help students remain grounded in their cultures across settings in the hopes of improving emotional/behavioral health outcomes. Through a stepped-wedge design randomized controlled trial, we examined the impact of CIP on cultural identity, cultural strengths, sense of community, and emotional/behavioral health across two cohorts of 44 AN students who ranged in age from 18 to 54 years. On average, students attended 75% of the program. The program had positive impacts on students' cultural identity development, endorsement of cultural strengths, sense of community with AN people at the university, and overall emotional/behavioral health. While gains in some outcomes were sustained over time, others were not, suggesting the potential benefits of a lengthened program. As the first program of its kind directed at AN university students of diverse cultural groups in urban settings, CIP shows promise for supporting emotional/behavioral health through cultural identity development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Masotti P, Dennem J, Bañuelos K, Seneca C, Valerio-Leonce G, Inong CT, King J. The Culture is Prevention Project: measuring cultural connectedness and providing evidence that culture is a social determinant of health for Native Americans. BMC Public Health 2023; 23:741. [PMID: 37085784 PMCID: PMC10120477 DOI: 10.1186/s12889-023-15587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others. Hundreds of years across many generations have taught that culture-based activities and interventions improve Native/Indigenous health and wellbeing. We explore if increased Native American culture/cultural connectedness is associated with better mental health/well-being and physical health. METHODS We analyzed data from a two-phased study (N = 259 and N = 102) of 361 urban Native Americans in California (2018-2021). The 29 items validated Cultural Connectedness Scale-California (CCS-CA) measured Native culture/cultural connectedness. Mental health/well-being and physical health were assessed using the: modified Herth Hope Index (mHHI), Satisfaction with Life (SWL), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R-10), Substance Abuse (CAGE-AID), and Health Related Quality of Life (HRQOL). We conducted Pearson correlations and stepwise regression analyses with CCS-CA as the independent (predictor) variable to explore our main research questions: 1) Is increased Native American/Indigenous culture associated with: 1) better mental health/well-being; and 2) better physical health? RESULTS Increased Native/Indigenous culture (CCS-CA scores) is significantly associated with better mental health/well-being (mHHI, p < .001) and satisfaction with life (SWL, p < .001) predicts good physical health days (HRQOL, p < .001). Increased connection to Native American/Indigenous culture (CCS-CA scores) is significantly associated with decreased risk for depression (CESD-R-10, p < .0) and substance abuse and (CAGE-AID, p < .07). Significant results for culture as protective against risk for substance abuse (CAGE-AID) was most likely affected (p value approaching significance) due to an error in language on the measure (i.e., created double negative). CONCLUSIONS Native American/Indigenous culture is a predictor of improved outcomes for mental health/well-being and physical healthy days. Native culture is an important social determinant of health. We add to the evidence that Native/Indigenous culture (i.e., cultural connectedness) be considered an important intervention objective and health-related outcome measure.
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Affiliation(s)
- Paul Masotti
- Native American Health Center, Community Wellness Department, 3124 International Blvd., Oakland, CA, 94601, USA.
| | - John Dennem
- Claremont Graduate School Applied Social Psychology Health and Prevention Lab, 150 E. 10Th Street, Claremont, CA, 91711, USA
| | - Karina Bañuelos
- Native American Health Center, Community Wellness Department, 3124 International Blvd., Oakland, CA, 94601, USA
| | - Cheyenne Seneca
- Native American Health Center, Community Wellness Department, 3124 International Blvd., Oakland, CA, 94601, USA
| | - Gloryanna Valerio-Leonce
- Native American Health Center, Community Wellness Department, 3124 International Blvd., Oakland, CA, 94601, USA
| | | | - Janet King
- Native American Health Center, Community Wellness Department, 3124 International Blvd., Oakland, CA, 94601, USA
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Dong L, D'Amico EJ, Dickerson DL, Brown RA, Palimaru AI, Johnson CL, Troxel WM. Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth. Sleep Health 2023; 9:4-10. [PMID: 36328921 PMCID: PMC9991968 DOI: 10.1016/j.sleh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth. DESIGN Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household. RESULTS Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p < .001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]). CONCLUSION Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.
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Affiliation(s)
- Lu Dong
- RAND Corporation, Santa Monica, California, USA.
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | | | | | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, California, USA
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14
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Lillie KM, Shane A, Jansen KJ, Trinidad SB, Shaw JL. Recovery from alcohol among urban Alaska Native and American Indian people. J Ethn Subst Abuse 2023; 22:154-170. [PMID: 34033515 PMCID: PMC8613305 DOI: 10.1080/15332640.2021.1918599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alaska Native and American Indian (ANAI) people experience dramatic alcohol-related health disparities compared to the general US population. Although the majority of ANAI people reside in urban settings (>70%), data are sparse on alcohol abstinence among urban ANAI people with alcohol use disorder (AUD). We conducted a qualitative study using a phenomenological approach to examine the experiences of 20 urban ANAI adults recovering from AUD. Participants' narratives had their own unique dimensions but shared a clear, interrelated trajectory of pre-alcohol recovery, a turning point, and ongoing alcohol recovery. All participants reported a combination of external and internal motivation to stop using alcohol.
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15
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Kell PA, Huber FA, Street EN, Shadlow JO, Rhudy JL. Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2022; 56:1116-1130. [PMID: 35775809 PMCID: PMC9924047 DOI: 10.1093/abm/kaac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset. PURPOSE This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs. METHODS Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants. RESULTS NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures. CONCLUSIONS Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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16
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Samuel-Nakamura C, Brecht ML, Arbing R. Emergency Department Use by Women Experiencing Homelessness in Los Angeles, California, USA. WOMEN'S HEALTH REPORTS 2022; 3:593-600. [PMID: 35814610 PMCID: PMC9258795 DOI: 10.1089/whr.2021.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/13/2022]
Abstract
Background: This article reports on the use of hospital Emergency Departments (EDs) in women experiencing homelessness in Los Angeles, California. Women 18 years of age or older were recruited from homeless day centers in Los Angeles to participate in this study. Materials and Methods: A self-report questionnaire on health status, demographics, and emergency service use was completed by study participants. Results: In this study of women experiencing homelessness, 64% utilized the ED within the past year. The mean number of ED use was 3.63 (range 0–20) visits in the past year. Higher frequency visits were significantly associated with several mental health conditions (p = 0.016), physical disability (p = 0.001), and traumatic brain injury (p = 0.013). Conclusions: The physical and psychological impacts of the homelessness experience can be enormous, affecting the homeless individually and collectively. Study findings may help to understand how to improve services that support and meet the needs of women experiencing homelessness such as patient and family-centered care and trauma-informed care in the ED.
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Affiliation(s)
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Rachel Arbing
- School of Nursing, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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17
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Michels SY, Freeman RE, Williams E, Albers AN, Wehner BK, Rechlin A, Newcomer SR. Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017. Prev Med Rep 2022; 27:101817. [PMID: 35656223 PMCID: PMC9152883 DOI: 10.1016/j.pmedr.2022.101817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study’s objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0–24 months in Montana, a large and primarily rural U.S. state. Data from Montana’s immunization information system (IIS) for children born 2015–2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.
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Affiliation(s)
- Sarah Y. Michels
- Yale School of Public Health, New Haven, CT, United States
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- Corresponding author at: University of Montana, Center for Population Health Research, 32 Campus Drive, Skaggs 173, Missoula, MT 59804, United States.
| | - Rain E. Freeman
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Elizabeth Williams
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
- All Nations Health Center, Missoula, MT, United States
| | - Alexandria N. Albers
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
| | - Bekki K. Wehner
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Annie Rechlin
- Montana Department of Public Health and Human Services, Immunization Section, Helena, MT, United States
| | - Sophia R. Newcomer
- University of Montana, Center for Population Health Research, Missoula, MT, United States
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, United States
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18
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Soto C, West AE, Ramos GG, Unger JB. Substance and Behavioral Addictions among American Indian and Alaska Native Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2974. [PMID: 35270667 PMCID: PMC8910676 DOI: 10.3390/ijerph19052974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This paper examines substance and behavioral addictions among American Indian and Alaska Natives (AIAN) to identify the structural and psychosocial risk and cultural protective factors that are associated with substance use and behavioral addictions. METHODS Five databases were used to search for peer reviewed articles through December 2021 that examined substance and behavioral addictions among AIANs. RESULTS The literature search identified 69 articles. Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions. CONCLUSIONS There is a dearth of research on behavioral addictions among AIANs. Unique risk factors in AIAN communities such as historical trauma and socioeconomic challenges have interfered with traditional cultural resilience factors and have increased the risk of behavioral addictions. Future research on resilience factors and effective prevention and treatment interventions could help AIANs avoid behavioral addictions.
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Affiliation(s)
- Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
| | - Amy E. West
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA;
| | - Guadalupe G. Ramos
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA; (G.G.R.); (J.B.U.)
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19
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Pham TV, Pomerville A, Burrage RL, Gone JP. An interview-based evaluation of an Indigenous traditional spirituality program at an urban American Indian health clinic. Transcult Psychiatry 2022:13634615221076706. [PMID: 35200047 DOI: 10.1177/13634615221076706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.
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Affiliation(s)
- Tony V Pham
- Department of Global Health and Social Medicine, 1811Harvard Medical School, Boston, MA
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Andrew Pomerville
- Department of Psychology, 1259University of Michigan, Ann Arbor, MI
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Rachel L Burrage
- Department of Social Work, 3949University of Hawaii at Mānoa, Honolulu, Hawaii
- Department of Anthropology, 1812Harvard University, Cambridge, MA
| | - Joseph P Gone
- Department of Anthropology, 1812Harvard University, Cambridge, MA
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20
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Blue Bird Jernigan V, Taniguchi T, Haslam A, Williams MB, Maudrie TL, Nikolaus CJ, Wetherill MS, Jacob T, Love CV, Sisson S. Design and Methods of a Participatory Healthy Eating Intervention for Indigenous Children: The FRESH Study. Front Public Health 2022; 10:790008. [PMID: 35296044 PMCID: PMC8920553 DOI: 10.3389/fpubh.2022.790008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/26/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To increase vegetable and fruit intake, reduce body mass index (BMI), and improve parental blood pressure among American Indian families. Design Randomized, wait-list controlled trial testing a multi-level (environmental, community, family, and individual) multi-component intervention with data collection at baseline and 6 months post-intervention. Setting Tribally owned and operated Early Childhood Education (ECE) programs in the Osage Nation in Oklahoma. Participants American Indian families (at least one adult and one child in a ECE program). A sample size of 168 per group will provide power to detect differences in fruit and vegetable intake. Intervention The 6-month intervention consisted of a (1) ECE-based nutrition and gardening curriculum; (2) nutrition education and food sovereignty curriculum for adults; and (3) ECE program menu modifications. Main Outcome Measures The primary outcome is increase in fruit and vegetable intake, assessed with a 24-h recall for adults and plate weight assessments for children. Secondary outcomes included objective measures of BMI among adults and children and blood pressure among adults.
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Affiliation(s)
- Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States,*Correspondence: Valarie Blue Bird Jernigan
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Mary B. Williams
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Tara L. Maudrie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cassandra J. Nikolaus
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Tvli Jacob
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Charlotte V. Love
- School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Susan Sisson
- Department of Nutritional Sciences, University of Oklahoma College of Allied Health, Oklahoma City, OK, United States
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21
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Pomerville A, Kawennison Fetter A, Gone JP. American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers. QUALITATIVE HEALTH RESEARCH 2022; 32:465-478. [PMID: 34919004 DOI: 10.1177/10497323211057857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client's specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.
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Affiliation(s)
- Andrew Pomerville
- Department of Psychology, 1259University of Michigan, Ann Arbor, MI, USA
| | - Anna Kawennison Fetter
- Department of Counseling Psychology, 5228University of Wisconsin-Madison, Madison, WI, USA
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anthropology, 1812Harvard University, Cambridge, MA, USA
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22
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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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23
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Skewes MC, Gameon JA, Hallum-Montes R, Ricker A. Determinants of Relapse and Opportunities for Growth: Perspectives on Substance Use among American Indian Community Members. J Psychoactive Drugs 2021; 53:474-482. [PMID: 34706631 PMCID: PMC8692388 DOI: 10.1080/02791072.2021.1986241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2023]
Abstract
Resulting from generations of historical oppression and systemic racism, American Indian and Alaska Native (AI/AN) communities experience serious health disparities associated with substance use disorders (SUDs). As part of a longstanding community-based participatory research intervention development project, our partnership of academic and community co-researchers conducted seven focus groups (N = 35) to understand community stakeholders' perspectives on substance use, relapse, and recovery on a rural AI reservation. Participants included cultural leaders (n = 10), SUD treatment providers (n = 5), people with SUD (n = 10), and affected family members (n = 10). Cultural leaders viewed relapse as symptomatic of historical oppression, whereas other stakeholder groups attributed relapse to individual and interpersonal risk factors such as peer influence, lack of family support, and traumatic stress. All participant groups recognized relapse as a normative aspect of recovering from SUD that presents new opportunities for learning and growth. Specifically, regaining humility, learning to ask for help, recognizing one's triggers, and strengthening commitment to change were identified as learning outcomes for people with SUD. For family members, relapse provided the opportunity to practice forgiveness and compassion, two important cultural values. All groups emphasized the importance of grounding interventions in cultural values and traditions.
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Gonzalez VM, Skewes MC. Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem. Alcohol Clin Exp Res 2021; 45:2309-2321. [PMID: 34837658 PMCID: PMC8642279 DOI: 10.1111/acer.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem. METHODS Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use. RESULTS Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use. CONCLUSIONS Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.
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Landry MJ, Gundersen C, Eicher-Miller HA. Food Insecurity on College and University Campuses: A Context and Rationale for Solutions. J Acad Nutr Diet 2021; 122:519-524. [PMID: 34718223 DOI: 10.1016/j.jand.2021.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew J Landry
- Stanford University, School of Medicine, Stanford Prevention Research Center, Palo Alto, CA.
| | - Craig Gundersen
- Baylor University, Baylor Collaborative on Hunger and Poverty (BCHP), and Department of Economics, Waco, TX
| | - Heather A Eicher-Miller
- Purdue University, College of Health and Human Sciences, Department of Nutrition Science, West Lafayette, IN
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Schick MR, Kirk-Provencher KT, Goldstein SC, Nalven T, Spillane NS. A Framework for the Adaptation of Positive Psychological Interventions to North American Indigenous Populations. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:913-922. [PMID: 34296375 PMCID: PMC8501455 DOI: 10.1007/s11121-021-01282-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Positive psychology research has led to the development of brief interventions designed to promote positive emotions: positive psychological interventions (PPIs). Randomized controlled trials examining PPIs have found them to be effective in increasing well-being and decreasing depressive symptoms. PPIs have been studied in samples consisting primarily of White Americans; however, PPIs may be useful for members of North American Indigenous groups. PPIs align well with Indigenous views on health, which tend to be strengths-based, holistic, and encompassing the whole body (including the medicine wheel's four dimensions of spirit, mind, heart, and body). This paper provides a framework for the adaptation of PPIs for Indigenous communities and a review of preliminary data on the relationships between positive psychological characteristics and health outcomes including substance use. Implications include the potential widespread impact of culturally adapted PPIs given their alignment with Indigenous thoughts on health and relative ease of administration.
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Affiliation(s)
- Melissa R Schick
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Katelyn T Kirk-Provencher
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Silvi C Goldstein
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Tessa Nalven
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Nichea S Spillane
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
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Hebert LE, Sarche MC. Pre-pregnancy and Prenatal Alcohol use Among American Indian and Alaska Native and Non-Hispanic White Women: Findings from PRAMS in Five States. Matern Child Health J 2021; 25:1392-1401. [PMID: 33959856 DOI: 10.1007/s10995-021-03159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Estimates of prenatal alcohol use among American Indian and Alaska Native (AI/AN) women are limited. This study sought to characterize pre-pregnancy and prenatal alcohol use among AI/AN women in the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset, evaluate variation in alcohol use by state and rural/urban residence, and evaluate associations between potential risk factors and prenatal alcohol use among AI/AN and non-Hispanic white (NHW) women. METHODS We pooled PRAMS data from five states (Alaska, New Mexico, Oklahoma, South Dakota and Washington) from 2015 to 2017. We estimated the prevalence of pre-pregnancy and pregnancy risk factors, and alcohol use by race and examined alcohol use by state and rural/urban residence among AI/AN women. We conducted bivariate and multivariable logistic regression modelling to estimate the association between each risk factor of interest and the odds of prenatal alcohol use for AI/AN and NHW women. RESULTS AI/AN women were less likely to report pre-pregnancy alcohol use compared to NHW women (56% vs. 76%, p < 0.0001). Among women who reported drinking pre-pregnancy, AI/AN women were more likely than NHW women to report drinking 1 or more drinks during pregnancy (4.3% vs. 2.4, p = 0.0049). For AI/AN women, older age and experiencing homelessness (aOR = 2.76; 95% CI 1.16-6.55) increased odds of prenatal alcohol use. For NHW women, having a college education (aOR = 4.06; 95% CI 1.19-13.88) and urban residence (aOR = 1.88; 95% CI 1.40-2.53) increased odds of prenatal alcohol use. CONCLUSIONS Factors associated with prenatal alcohol use differ between AI/AN women and NHW women, suggesting the need for tailored interventions.
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Affiliation(s)
- Luciana E Hebert
- Institute for Research and Education Advancing Community Health (IREACH), Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA.
| | - Michelle C Sarche
- Colorado School of Public Health, University of Colorado Denver, 13055 E. 17th Place, F800 Nighthorse Campbell Native Health Bldg. Rm 342, Anschutz Medical Campus, Aurora, CO, 80045, USA
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D'Amico EJ, Dickerson DL, Brown RA, Klein DJ, Agniel D, Johnson C. Unveiling an 'invisible population': health, substance use, sexual behavior, culture, and discrimination among urban American Indian/Alaska Native adolescents in California. ETHNICITY & HEALTH 2021; 26:845-862. [PMID: 30626198 PMCID: PMC7510334 DOI: 10.1080/13557858.2018.1562054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
Objectives: There are limited public health data on urban American Indian/Alaska Native (AI/AN) populations, particularly adolescents. The current study attempted to address gaps by providing descriptive information on experiences of urban AI/AN adolescents across northern, central, and southern California.Design: We describe demographics and several behavioral health and cultural domains, including: alcohol and other drug (AOD) use, risky sexual behavior, mental and physical health, discrimination experiences, involvement in traditional practices, and cultural pride and belonging. We recruited 185 urban AI/AN adolescents across northern, central, and southern California from 2014 to 2017 who completed a baseline survey as part of a randomized controlled intervention trial.Results: Average age was 15.6 years; 51% female; 59% of adolescents that indicated AI/AN descent also endorsed another race or ethnicity. Rates of AOD use in this urban AI/AN sample were similar to rates for Monitoring the Future. About one-third of adolescents reported ever having sexual intercourse, with 15% reporting using alcohol or drugs before sex. Most reported good mental and physical health. Most urban AI/AN adolescents participated in traditional practices, such as attending Pow Wows and learning their tribal history. Adolescents also reported discrimination experiences, including being a victim of racial slurs and discrimination by law enforcement.Conclusions: This study describes a select sample of California urban AI/AN adolescents across several behavioral health and cultural domains. Although these adolescents reported numerous discrimination experiences and other stressors, findings suggest that this sample of urban AI/AN teens may be particularly resilient with regard to behavioral health.
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Affiliation(s)
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, USA
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Shadlow JO, Kell PA, Toledo TA, Huber FA, Kuhn BL, Lannon EW, Hellman N, Sturycz CA, Ross EN, Rhudy JL. Sleep Buffers the Effect of Discrimination on Cardiometabolic Allostatic Load in Native Americans: Results from the Oklahoma Study of Native American Pain Risk. J Racial Ethn Health Disparities 2021; 9:1632-1647. [PMID: 34319571 DOI: 10.1007/s40615-021-01103-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Compared to other racial/ethnic groups, Native Americans (NAs) are more likely to develop health conditions associated with allostatic load (stress-related wear-and-tear). Psychosocial factors (i.e., adverse life events, discrimination, psychological distress) often promote stress and may help explain greater allostatic load in NAs. Moreover, previous research suggests sleep may either mediate or moderate the effects of some psychosocial stressors, like discrimination, on allostatic load. The current study investigated the relationship between adverse life events, discrimination, psychological stress, sleep, and cardiometabolic load. METHODS Using a sample of 302 healthy, chronic pain-free NAs and non-Hispanic White (NHW) participants, bootstrapped mediation analyses were conducted to determine whether the relationship between NA race/ethnicity and cardiometabolic allostatic load (composite score of body mass index, mean arterial pressure, and heart rate variability) was mediated by psychosocial stressors. Models also assessed whether sleep disturbance served as an additional mediator or a moderator to the effects. RESULTS Consistent with prior research, we found that NAs experienced greater discrimination, adverse life events (potentially traumatic events), and cardiometabolic allostatic load than NHWs. Further, discrimination was associated with increased psychological stress for NAs, but this did not explain why NAs experience higher cardiometabolic allostatic load. A moderating effect of sleep on discrimination was found, such that discrimination partially contributed to the relationship between NA race/ethnicity and cardiometabolic allostatic load, but only for participants reporting greater sleep disturbance. Implications These findings highlight that good sleep can buffer the effect of psychosocial stress on cardiometabolic allostatic load in Native Americans.
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Affiliation(s)
- Joanna O Shadlow
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA.
| | - Parker A Kell
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Tyler A Toledo
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Felicitas A Huber
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Bethany L Kuhn
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Edward W Lannon
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Cassandra A Sturycz
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Erin N Ross
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
| | - Jamie L Rhudy
- Department of Psychology, The University of Tulsa, 800 South Tucker Drive, Tulsa, OK, 74104, USA
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Small-Rodriguez D, Akee R. Identifying Disparities in Health Outcomes and Mortality for American Indian and Alaska Native Populations Using Tribally Disaggregated Vital Statistics and Health Survey Data. Am J Public Health 2021; 111:S126-S132. [PMID: 34314207 PMCID: PMC8495633 DOI: 10.2105/ajph.2021.306427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the impact of disaggregated mortality and health surveillance data on the ability to identify health disparities for American Indian and Alaska Native (AI/AN) subpopulations. Methods. We conducted a systematic review of reporting categories for AI/AN decedents on official death certificates for all 50 US states. Using public data from the 2017-2018 California Health Interview Survey (CHIS), we conducted bivariate and multivariate analyses to assess disparities in health conditions and outcomes for tribally enrolled and non‒tribally enrolled AI/AN persons compared with non-Hispanic Whites. Results. There was no standard for the collection of tribal enrollment data or AI/AN race on death certificates across all 50 states. There were stark differences in the incidence and prevalence of various health risk factors and chronic diseases for the tribally enrolled AI/AN subpopulation, non‒tribally enrolled AI/AN subpopulation, and non-Hispanic White comparison group. Conclusions. The collection of tribal enrollment data in vital statistics and health surveillance systems is necessary to identify and respond to health disparities among AI/AN subpopulations. These efforts must be conducted in partnership with tribal nations and consider Indigenous data sovereignty.
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Affiliation(s)
- Desi Small-Rodriguez
- Desi Small-Rodriguez (Northern Cheyenne and Chicana) is with the Department of Sociology and American Indian Studies Program at the University of California, Los Angeles. Randall Akee (Native Hawaiian) is with the Department of Public Policy and American Indian Studies Program at the University of California, Los Angeles
| | - Randall Akee
- Desi Small-Rodriguez (Northern Cheyenne and Chicana) is with the Department of Sociology and American Indian Studies Program at the University of California, Los Angeles. Randall Akee (Native Hawaiian) is with the Department of Public Policy and American Indian Studies Program at the University of California, Los Angeles
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John-Henderson NA, Oosterhoff B, Kothe KM, Kampf TD, Hall B, Johnson LR, LaFromboise ME, Malatare M, Salois EM, Adams AK, Carter JR. Loneliness and sleep in the American Indian Blackfeet community. Sleep Health 2021; 7:429-435. [PMID: 34217696 DOI: 10.1016/j.sleh.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sleep is largely understudied in American Indians (AIs), even though sleep is implicated in the chronic diseases which disproportionately affect AI communities. OBJECTIVE To investigate relationships between daily self-reported loneliness and sleep as measured with actigraphy. METHODS In a sample of 98 Blackfeet adults living on the Blackfeet reservation in Montana, we used Ecological Momentary Assessment and actigraphy over a week-long period to investigate relationships between loneliness and sleep. Loneliness was measured daily using the Short Loneliness Scale and actigraphy was used to measure total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). RESULTS Using a series of generalized linear mixed-effects models controlling for demographic characteristics, anxiety and depressive symptoms, and adverse childhood experiences, we found that those who were lonelier had higher WASO and SOL, and lower SE relative to those who were less lonely. Within-subject effects indicate that participants who were lonelier for a given day relative to their own weekly average had higher WASO that night relative to their own weekly average. CONCLUSIONS Our findings provide initial preliminary evidence suggesting that loneliness may be a psychosocial factor which contributes to poor sleep in AI communities.
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Affiliation(s)
- Neha A John-Henderson
- Montana State University, Department of Psychology, Bozeman, Montana, USA; Montana State University, Center for American Indian and Rural Health Equity, Bozeman, Montana, USA.
| | - Benjamin Oosterhoff
- Montana State University, Department of Psychology, Bozeman, Montana, USA; Montana State University, Center for American Indian and Rural Health Equity, Bozeman, Montana, USA
| | - Karalee M Kothe
- Montana State University, Department of Psychology, Bozeman, Montana, USA
| | - Taylor D Kampf
- Montana State University, Department of Psychology, Bozeman, Montana, USA
| | | | | | | | | | - Emily M Salois
- Montana State University, Center for American Indian and Rural Health Equity, Bozeman, Montana, USA
| | - Alexandra K Adams
- Montana State University, Center for American Indian and Rural Health Equity, Bozeman, Montana, USA
| | - Jason R Carter
- Montana State University, Department of Psychology, Bozeman, Montana, USA; Montana State University, Department of Human Health and Development, Bozeman, Montana, USA
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Heck JL, Jones EJ, Bohn D, McCage S, Parker JG, Parker M, Pierce SL, Campbell J. Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review. J Womens Health (Larchmt) 2021; 30:220-229. [PMID: 33211616 DOI: 10.1089/jwh.2020.8890] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.
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Affiliation(s)
- Jennifer L Heck
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Emily J Jones
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Diane Bohn
- Cass Lake Indian Health Service, Cass Lake, Minnesota, USA
| | - Shondra McCage
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Mahate Parker
- OB Hospitalist Group, Greenville, South Carolina, USA
| | - Stephanie L Pierce
- Department of Maternal-Fetal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Nortjé N, Jones-Bonofiglio K, Sotomayor CR. Exploring values among three cultures from a global bioethics perspective. Glob Bioeth 2021; 32:1-14. [PMID: 33658749 PMCID: PMC7872551 DOI: 10.1080/11287462.2021.1879462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/18/2021] [Indexed: 11/17/2022] Open
Abstract
The United Nations Educational, Scientific and Cultural Organisation's (UNESCO) Declaration on Bioethics and Human Rights refers to the importance of cultural diversity and pluralism in ethical discourse and care of humanity. The aim of this meta-narrative review is to identify indigenous ethical values pertaining to the Ojibway (Canada), Xhosa (South Africa), and Mayan (Mexico and Central American) cultures from peer-reviewed sources and cultural review, and to ascertain if there are shared commonalities. Three main themes were identified, namely illness, healing, and health care choices. Illness was described with a more complex and dynamic picture than from the western view, as illness is not considered to be one dimensional. Healing needs to take place on various levels in order to restore a state of equilibrium between the different spheres. Health care choices were also considered from a multi-level perspective. In all three of the indigenous cultures explored, good decision-making is seen to have occurred when choices are informed by commitments to one's moral and ethical responsibilities towards the community, nature, and the spirit world.
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Affiliation(s)
- Nico Nortjé
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of the Western Cape, Bellville, South Africa
- Lakehead University Centre for Health Care Ethics, Thunder Bay, Canada
| | - Kristen Jones-Bonofiglio
- Lakehead University Centre for Health Care Ethics, Thunder Bay, Canada
- Associated Medical Services (AMS Healthcare) Phoenix Fellow, Toronto, Canada
| | - Claudia R. Sotomayor
- Georgetown University, Washington, DC, USA
- Research Scholar of UNESCO Chair in Bioethics and Human Rights, Rome, Italy
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Brown RA, Dickerson DL, Klein DJ, Agniel D, Johnson CL, D’Amico EJ. Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being. YOUTH & SOCIETY 2021; 53:54-75. [PMID: 34176991 PMCID: PMC8232344 DOI: 10.1177/0044118x19840048] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.
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Gone JP, Tuomi A, Fox N. The Urban American Indian Traditional Spirituality Program: Promoting Indigenous Spiritual Practices for Health Equity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:279-289. [PMID: 32597511 DOI: 10.1002/ajcp.12436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Beginning in 2009, Detroit's urban American Indian health center entered into a collaborative and participatory partnership with a university research team. The purpose of the partnership was to incorporate Indigenous traditional healing practices into the health and wellness services at this center. Following extensive consultation with stakeholders at the center, we were commissioned by local decision-makers to develop a program tailored for members of the urban American Indian community that would introduce and orient these individuals to meaningful participation in Indigenous traditional spirituality. The Urban American Indian Traditional Spirituality Program is a structured curriculum for American Indian community members that introduces and orients participants to meaningful engagement with sacred practices associated with the sweat lodge ceremony. The signature innovation of this program was the recasting of traditional socialization practices into a structured, didactic curriculum that could initiate an enduring spiritual devotional life for American Indian participants toward improved health and well-being. Created primarily "by Indians, for Indians," the collaboratively designed curriculum draws on cultural strengths and spiritual empowerment to advance health equity for these marginalized populations.
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Affiliation(s)
- Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anthropology, Harvard University, Cambridge, MA, USA
| | - Ashley Tuomi
- American Indian Health & Family Services of Southeast Michigan, Inc., Detroit, MI, USA
| | - Nickole Fox
- American Indian Health & Family Services of Southeast Michigan, Inc., Detroit, MI, USA
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Kulis SS, Tsethlikai M, Harthun ML, Hibbeler P, Ayers SL, Deschine Parkhurst N. Parenting in 2 worlds: Effects of a culturally grounded parenting intervention for urban American Indians on participant cultural engagement. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2020; 26:437-446. [PMID: 31886683 PMCID: PMC7326650 DOI: 10.1037/cdp0000315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Culturally appropriate, evidence-based prevention programs are seldom available to the growing majority of American Indians (AIs) who now live in cities. Parenting in 2 Worlds (P2W), a culturally grounded parenting intervention, was created to strengthen family functioning and reduce behavioral health risks in urban AI families from diverse tribal backgrounds. OBJECTIVES This study reports on the AI cultural engagement of the P2W participants as an outcome of the intervention. METHOD Data came from 575 parents of AI children (ages 10-17) in a randomized controlled trial in three Arizona cities. Parents were recruited through urban Indian centers and randomized to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W). Both P2W and HF2W consisted of 10 workshops delivered weekly by AI community facilitators. Pretests and posttests measured identification and engagement with traditional AI heritage, culture and practices. Tests of the efficacy of P2W versus HF2W used baseline adjusted regression models using FIML estimation to adjust for attrition, including random effects (site, facilitator), and controlling dosage. Moderated treatment effects by pretest levels of cultural engagement were tested with mean centered interactions. RESULTS Compared to parents in HF2W, those in P2W reported significantly larger increases in AI ethnic identity, AI spirituality, and positive mainstream cultural identification. Increases in cultural engagement were significantly larger for P2W participants who were relatively less culturally engaged at pretest. CONCLUSIONS Culturally adapted parenting interventions like P2W that effectively build on AI cultural heritage can also promote greater AI cultural identification and involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Stephen S. Kulis
- Sanford School of Social and Family Dynamics, Arizona State University
- Southwest Interdisciplinary Research Center, Arizona State University
| | - Monica Tsethlikai
- Sanford School of Social and Family Dynamics, Arizona State University
- Southwest Interdisciplinary Research Center, Arizona State University
| | - Mary L. Harthun
- Southwest Interdisciplinary Research Center, Arizona State University
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Abstract
Gaps and transitions (disruptions) in perinatal insurance coverage disproportionately affect indigenous, Hispanic, and black non-Hispanic women. To measure the association between race–ethnicity and insurance status at preconception, delivery, and postpartum and the frequency of insurance gaps and transitions (disruptions) across these time points.
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Ly KN, Miniño AM, Liu SJ, Roberts H, Hughes EM, Ward JW, Jiles RB. Deaths Associated With Hepatitis C Virus Infection Among Residents in 50 States and the District of Columbia, 2016-2017. Clin Infect Dis 2020; 71:1149-1160. [PMID: 31586173 PMCID: PMC11089524 DOI: 10.1093/cid/ciz976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning. METHODS To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C., using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year. RESULTS In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07-4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P < .05). Death rates ranged from a low of 1.60 (95% CI, 1.07-2.29) in Maine to a high of 11.84 (95% CI, 10.82-12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945-1965. CONCLUSIONS In 2016-2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C., and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Arialdi M Miniño
- Division of Vital Statistics, National Center for Health Statistics, US Centers for Disease Control and Prevention, Hyattsville, Maryland, USA, Pittsburg, Pennsylvania, USA
| | - Stephen J Liu
- Graduate School of Public Health, University of Pittsburg, Pittsburg, Pennsylvania, USA
| | - Henry Roberts
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth M Hughes
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Ruth B Jiles
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Hswen Y, Hawkins JB, Sewalk K, Tuli G, Williams DR, Viswanath K, Subramanian SV, Brownstein JS. Racial and Ethnic Disparities in Patient Experiences in the United States: 4-Year Content Analysis of Twitter. J Med Internet Res 2020; 22:e17048. [PMID: 32821062 PMCID: PMC7474415 DOI: 10.2196/17048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups often face worse patient experiences compared with the general population, which is directly related to poorer health outcomes within these minority populations. Evaluation of patient experience among racial and ethnic minority groups has been difficult due to lack of representation in traditional health care surveys. OBJECTIVE This study aims to assess the feasibility of Twitter for identifying racial and ethnic disparities in patient experience across the United States from 2013 to 2016. METHODS In total, 851,973 patient experience tweets with geographic location information from the United States were collected from 2013 to 2016. Patient experience tweets included discussions related to care received in a hospital, urgent care, or any other health institution. Ordinary least squares multiple regression was used to model patient experience sentiment and racial and ethnic groups over the 2013 to 2016 period and in relation to the implementation of the Patient Protection and Affordable Care Act (ACA) in 2014. RESULTS Racial and ethnic distribution of users on Twitter was highly correlated with population estimates from the United States Census Bureau's 5-year survey from 2016 (r2=0.99; P<.001). From 2013 to 2016, the average patient experience sentiment was highest for White patients, followed by Asian/Pacific Islander, Hispanic/Latino, and American Indian/Alaska Native patients. A reduction in negative patient experience sentiment on Twitter for all racial and ethnic groups was seen from 2013 to 2016. Twitter users who identified as Hispanic/Latino showed the greatest improvement in patient experience, with a 1.5 times greater increase (P<.001) than Twitter users who identified as White. Twitter users who identified as Black had the highest increase in patient experience postimplementation of the ACA (2014-2016) compared with preimplementation of the ACA (2013), and this change was 2.2 times (P<.001) greater than Twitter users who identified as White. CONCLUSIONS The ACA mandated the implementation of the measurement of patient experience of care delivery. Considering that quality assessment of care is required, Twitter may offer the ability to monitor patient experiences across diverse racial and ethnic groups and inform the evaluation of health policies like the ACA.
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Affiliation(s)
- Yulin Hswen
- Boston Children's Hospital, Boston, MA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States.,Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, United States.,Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - Jared B Hawkins
- Innovation Program, Boston Children's Hospital, Boston, MA, United States.,Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
| | - Kara Sewalk
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - Gaurav Tuli
- Innovation Program, Boston Children's Hospital, Boston, MA, United States
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States.,Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
| | - K Viswanath
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States.,Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
| | - John S Brownstein
- Innovation Program, Boston Children's Hospital, Boston, MA, United States.,Computational Epidemiology Lab, Harvard Medical School, Boston, MA, United States
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Comparing vaccination coverage of American Indian children with White children in North Dakota. Public Health 2020; 186:78-82. [PMID: 32791340 DOI: 10.1016/j.puhe.2020.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objective of this study was to compare immunization rates of American Indian (AI) and White children in North Dakota and identify disparities in immunization rates by race. STUDY DESIGN The study design was to assess immunization coverage rates by race using immunization information system (IIS) data. METHODS Data from the North Dakota Immunization Information System (NDIIS) for children aged 19-35 months during quarter four of 2014, 2015, 2016, 2017 and 2018 were used to assess and compare immunization coverage rates for AI and White children. NDIIS data were also analyzed for timeliness of vaccine administration, Vaccines for Children (VFC) status, and the number of doses still needed to be considered up to date (UTD) with routinely recommended immunizations. RESULTS In quarter four of 2018 (Q4 2018), only 60% of AI children were UTD with the complete 4:3:1:3:3:1:4 vaccine series compared with 74.5% of White children of the same age. Fewer VFC-eligible AI children (59.1%) are UTD than VFC-eligible White children (68.7%). AI children were also more likely to be delayed at each immunization milestone, leading to fewer AI children to be UTD by 19 to 35 months of age. CONCLUSIONS This study shows that there is a racial disparity in immunization coverage rates between AI and White children in North Dakota. Public health and private healthcare providers should work to identify and address barriers to vaccination and should implement strategies to increase immunization rates for AI children.
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Mayer B, Joshweseoma L, Sehongva G. Environmental Risk Perceptions and Community Health: Arsenic, Air Pollution, and Threats to Traditional Values of the Hopi Tribe. J Community Health 2020; 44:896-902. [PMID: 30790123 DOI: 10.1007/s10900-019-00627-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
American Indian and Alaska Native populations experience chronic disparities in a wide range of health outcomes, many of which are associated with disproportionate exposures to environmental health hazards. In the American Southwest, many indigenous tribes experience challenges in securing access to sustainable and safe sources of drinking water, limiting air pollution emissions on and off tribal lands, and cleaning up hazardous contaminants left over from a legacy of natural resource extraction. To better understand how households perceive the risk of exposure to potential environmental health risks, we conducted six focus groups organized by age and geographic location on the Hopi reservation. Focus group participants (n = 41) were asked to reflect on changes in their natural and manmade environment and how their health might be influenced by any potential changes. By investigating these environmental risk perceptions, we were able to identify arsenic in drinking water and indoor air quality as significant exposures of concern. These risk perceptions were frequently anchored in personal and familial experiences with health problems such as cancer and asthma. Older focus group participants identified ongoing shifts away from tradition and cultural practices as increasing environmental health risks. Similar to other communities economically dependent on the extraction of natural resources, focus group participants described the need for behavioral modifications regarding environmental health risks rather than eliminating the sources of potential health risks entirely. Our results suggest the need for including traditional values and practices in future interventions to reduce environmental health risks.
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Affiliation(s)
- Brian Mayer
- School of Sociology, University of Arizona, P.O. Box 210027, Tucson, AZ, 87521, USA.
| | - Lorencita Joshweseoma
- Hopi Department of Health & Human Services, P.O. Box 123, Kykotsmovi, AZ, 86039, USA
| | - Gregory Sehongva
- Hopi Department of Health & Human Services, P.O. Box 123, Kykotsmovi, AZ, 86039, USA
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D'Amico EJ, Dickerson DL, Brown RA, Johnson CL, Klein DJ, Agniel D. Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial. J Subst Abuse Treat 2020; 111:86-99. [PMID: 32087841 PMCID: PMC7477923 DOI: 10.1016/j.jsat.2019.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, United States of America
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, LA, CA 90017, United States of America
| | - David J Klein
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Denis Agniel
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
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Tonigan JS, Venner K, Hirchak KA. Urban American Indian Adult Participation and Outcomes in Culturally Adapted and Mainstream Alcoholics Anonymous Meetings. ALCOHOLISM TREATMENT QUARTERLY 2020; 38:50-67. [PMID: 32051654 DOI: 10.1080/07347324.2019.1616512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Very little is known about American Indian (AI) adults' participation in Alcoholics Anonymous (AA) despite their elevated rates of negative sequelae due to heavy alcohol consumption and alcohol use disorders. This study sought to fill that gap and examined the engagement in AA by urban Southwest AI (S-AI) adult problem drinkers and whether enculturation and acculturation accounted for type of AA attended (mainstream versus culturally adapted AA; CA-AA). Additionally, we compared three and six-month drinking outcomes of urban S-AI adults by type of meeting attended. Sixty-one urban S-AI adults were consented and assessed at baseline, three and six-months. We examined the association between frequency of AA attendance and differences between types of meetings attended regressed on the outcomes of proportion abstinent days and drinks per drinking day. Results indicate that AA attendance is the model approach and assists urban S-AI adults in reducing their drinking. Despite higher engagement among those attending both AA and CA-AA, this did not translate into differential AA-related benefit which speaks to the need for additional research to assist AI adults in effectively reducing their alcohol use.
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Affiliation(s)
- J Scott Tonigan
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kamilla Venner
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Katherine A Hirchak
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
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Dent RB, Hagiwara N, Stepanova EV, Green TL. The role of feature-based discrimination in driving health disparities among Black Americans. ETHNICITY & HEALTH 2020; 25:161-176. [PMID: 29105509 DOI: 10.1080/13557858.2017.1398314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
Objective: A growing body of research finds that darker skin tone is often associated with poorer physical and mental health in Blacks. However, the psychosocial mechanisms underlying the skin tone-health link remain elusive. The present study seeks to address this knowledge gap by investigating the direct and indirect (through perceived discrimination, socioeconomic status, and self-esteem) effects of skin tone on self-reported physical and mental health.Design: An urban sample of 130 Blacks aged 35 and above completed a self-administered computerized survey as a part of larger cross-sectional study.Results: Self-esteem played a particularly important role in mediating the associations between skin tone and self-reported physical and mental health. This suggests that self-esteem could be a point of intervention to help Blacks with darker skin tone achieve better health.Conclusion: The present study highlights the important role feature-based discrimination plays in determining mental and physical health outcomes among Blacks.
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Affiliation(s)
- Randl B Dent
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Elena V Stepanova
- Department of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
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Hulen E, Hardy LJ, Teufel-Shone N, Sanderson PR, Schwartz AL, Begay RC. Community Based Participatory Research (CBPR): A Dynamic Process of Health care, Provider Perceptions and American Indian Patients' Resilience. J Health Care Poor Underserved 2019; 30:221-237. [PMID: 30827979 DOI: 10.1353/hpu.2019.0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
American Indians are disproportionately affected by factors that lead to health disparities, however many Native people demonstrate resilience when faced with health risks. Study objectives were to use a resilience framework to identify wellness strategies among American Indian people and to assess health care provider perceptions of American Indian wellness. Participants included 39 American Indian adults who self-reported resilient change and 22 health care providers who served American Indian patients. Thematic categories across American Indian and health care provider data were identified: 1) relationships inform resilience; 2) prejudice stymies resilience; and 3) place shapes resilience. Results indicated the salience of relationships in demonstrating resilience. Identified challenges and supporters of resilience are discussed.
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Verney SP, Suchy-Dicey AM, Cholerton B, Calhoun D, Nelson L, Montine TJ, Ali T, Longstreth WT, Buchwald D. The associations among sociocultural factors and neuropsychological functioning in older American Indians: The Strong Heart Study. Neuropsychology 2019; 33:1078-1088. [PMID: 31343235 PMCID: PMC8048411 DOI: 10.1037/neu0000574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Valid neuropsychological assessment is critical to the accurate diagnosis and effective treatment of diverse populations. American Indians and Alaska Natives experience substantial health disparities relative to the general U.S. POPULATION Given the dearth of studies on neuropsychological health in this population, we aimed to characterize neuropsychological performance among older American Indians with respect to age, sex, education, income, and language use. METHOD From 2010 to 2014, we recruited 818 American Indians aged 60 and older from the Cerebrovascular Disease and Its Consequences in American Indians Study, who comprised all of the surviving members of a cardiovascular study (Strong Heart Study). This cohort from 11 tribes resided on or near their home reservations in three geographic regions (Northern Plains, Southern Plains, and Southwest). Using a cross-sectional design investigating potential vascular brain injury, we administered a brief, targeted neuropsychological and motor function assessments. RESULTS Higher scores on neuropsychological tests were associated with younger age, female sex, more education, higher income, and less Native American language use. Similar associations were found for the motor tests, although men had higher scores on both motor function tests. After accounting for other sociocultural and health factors, age, sex, education, income, and Native American language use all had significant associations to the test scores. CONCLUSIONS Our findings may be used to guide research and inform clinical practice. The development of future normative studies for older American Indians will be more culturally appropriate when sociocultural factors are included. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Steven P Verney
- Department of Psychology and Psychology Clinical Neuroscience Center
| | | | | | | | - Lonnie Nelson
- Institute for Education and Research to Advance Community Health
| | | | | | | | - Dedra Buchwald
- Institute for Education and Research to Advance Community Health
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Heaton B, Crawford AJ, Wimsatt MA, Henshaw M, Riedy CA, Barker JC, Garcia RI. A storytelling intervention reduces childhood caries risk behaviors among American Indian and Alaska Native mothers in Northern California. J Public Health Dent 2019; 79:183-187. [PMID: 31012105 PMCID: PMC7236090 DOI: 10.1111/jphd.12318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/26/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers. METHODS Fifty-three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self-reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest-posttest design, with an additional six-month follow-up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors. RESULTS Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six-months was also observed. CONCLUSIONS The results of this intervention study suggest promise for traditional storytelling to increase oral health-related knowledge, beliefs, and behaviors among self-identified AIAN pregnant women and mothers.
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Affiliation(s)
- Brenda Heaton
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Andrew J. Crawford
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis, Sacramento, CA, USA
| | | | - Michelle Henshaw
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Christine A. Riedy
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Judith C. Barker
- Center to Address Disparities in Children’s Oral Health (CAN-DO), School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Raul I. Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Center for Research to Evaluate and Eliminate Dental Disparities (CREEDD), Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Tomayko EJ, Prince RJ, Cronin KA, Kim K, Parker T, Adams AK. The Healthy Children, Strong Families 2 (HCSF2) Randomized Controlled Trial Improved Healthy Behaviors in American Indian Families with Young Children. Curr Dev Nutr 2019; 3:53-62. [PMID: 31453428 PMCID: PMC6700460 DOI: 10.1093/cdn/nzy087] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/13/2018] [Accepted: 11/09/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND American Indian (AI) families experience a disproportionate risk of obesity due to a number of complex reasons, including poverty, historic trauma, rural isolation or urban loss of community connections, lack of access to healthy foods and physical activity opportunities, and high stress. Home-based obesity prevention interventions are lacking for these families. OBJECTIVE Healthy Children, Strong Families 2 (HCSF2) was a randomized controlled trial of a healthy lifestyle promotion/obesity prevention intervention for AI families. METHODS Four hundred and fifty dyads consisting of an adult primary caregiver and a child ages 2 to 5 y from 5 AI communities were randomly assigned to a monthly mailed healthy lifestyle intervention toolkit (Wellness Journey) with social support or to a child safety control toolkit (Safety Journey) for 1 y. The Wellness Journey toolkit targeted increased fruit/vegetable (F/V) intake and physical activity, improved sleep, decreased added sugar intake and screen time, and improved stress management (adults only). Anthropometrics were collected, and health behaviors were assessed via survey at baseline and at the end of Year 1. Adults completed surveys for themselves and the participating child. Repeated measures analysis of variance was used to assess change over the intervention period. RESULTS Significant improvements to adult and child healthy diet patterns, adult F/V intake, adult moderate-to-vigorous physical activity, home nutrition environment, and adult self-efficacy for health behavior change were observed in Wellness Journey compared with Safety Journey families. No changes were observed in adult body mass index (BMI), child BMI z-score, adult stress measures, adult/child sleep and screen time, or child physical activity. Qualitative feedback suggests the intervention was extremely well-received by both the families and our community partners across the 5 participating sites. CONCLUSIONS This multi-site community-engaged intervention addressed key gaps regarding family home-based approaches for early obesity prevention in AI communities and showed several significant improvements in health behaviors. Multiple communities are working to sustain intervention efforts. This trial was registered at clinicaltrials.gov as NCT01776255.
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Affiliation(s)
- Emily J Tomayko
- Nutrition, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
| | - Ronald J Prince
- Departments of Population Health, University of Wisconsin, Madison, WI
| | - Kate A Cronin
- Departments of Surgery, University of Wisconsin, Madison, WI
| | - KyungMann Kim
- Departments of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Tassy Parker
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - Alexandra K Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT
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Mera J, Joshi K, Thornton K, Box T, Scott J, Sedillo M, Deming P, David C, Essex W, Manch R, Kohli A. Retrospective Study Demonstrating High Rates of Sustained Virologic Response After Treatment With Direct-Acting Antivirals Among American Indian/Alaskan Natives. Open Forum Infect Dis 2019; 6:ofz128. [PMID: 31289725 PMCID: PMC6610205 DOI: 10.1093/ofid/ofz128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
Background Treatment for chronic hepatitis C virus (HCV) has rapidly evolved to simple, well-tolerated, all-oral regimens of direct-acting antivirals (DAAs). There are few data on the epidemiology of HCV in American Indians/Alaska Natives (AI/ANs), a population disproportionately affected by HCV. Methods In this retrospective cohort study, all HCV-infected AI/AN patients treated with DAA therapies between January 1, 2014, and February 24, 2016, in specialty clinics or by primary care clinicians participating in Extension for Community Healthcare Outcomes (ECHO) were included. Demographic, clinical, and virologic data on all patients treated for HCV from pretreatment through sustained virologic response at 12 weeks (SVR12) were collected. Results Two hundred eighty patients were included; 71.1% of patients (n = 199) were infected with genotype 1 (GT1), 18.2% (n = 51) with GT2, and 10.7% with (n = 30) GT3. At baseline, 26.1% (n = 73) patients had cirrhosis and 22.6% (n = 56) had active substance use disorder; eighty-eight percent (n = 232) of patients achieved SVR12. Among the 165 GT1 patients treated with sofosbuvir (SOF)/ledipasvir for 8, 12, and 24 weeks, SVR12 was achieved by 91.5% (n = 54), 92.2% (n = 71), and 100% (n = 13), respectively. Among GT2 patients, 87.2% (n = 34) and 71.4% (n = 5) treated with 12 and 16 weeks of SOF/ribavirin (RBV) achieved SVR12, respectively. Among GT3 patients, 100% (n = 2) and 83.3% (n = 20) treated with 12 and 24 weeks of SOF/RBV achieved SVR12, respectively. SVR12 rates remained high among patients with active substance use disorder. Conclusions DAA therapies are highly efficacious in HCV-infected AI/ANs. SVR12 rates remained high among patients with active substance use disorder. More steps must be taken to increase access to treatment for this underserved, vulnerable population.
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Affiliation(s)
- Jorge Mera
- Division of Infectious Diseases, Cherokee Nation W.W. Hastings Hospital, Tahlequah, Oklahoma
| | - Kartik Joshi
- Division of Hepatology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Institute for Liver Health, Chandler, Arizona
| | - Karla Thornton
- Division of Infectious Diseases, Project ECHO, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - Terry Box
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah
| | - John Scott
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
| | - Miranda Sedillo
- Division of Infectious Diseases, Project ECHO, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - Paulina Deming
- Division of Infectious Diseases, Project ECHO, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - Crystal David
- Division of Infectious Diseases, Cherokee Nation W.W. Hastings Hospital, Tahlequah, Oklahoma
| | - Whitney Essex
- Division of Infectious Diseases, Cherokee Nation W.W. Hastings Hospital, Tahlequah, Oklahoma
| | - Richard Manch
- Division of Hepatology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.,Institute for Liver Health, Chandler, Arizona
| | - Anita Kohli
- Institute for Liver Health, Chandler, Arizona.,Division of Infectious Disease, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Zhau J, Weber T, Hanson J, Nelson M, Birger C, Puumala S. A County-Level Health Index to Capture Geographic Variation in Health Conditions in North Dakota, South Dakota, and Minnesota. SOUTH DAKOTA MEDICINE : THE JOURNAL OF THE SOUTH DAKOTA STATE MEDICAL ASSOCIATION 2019; 72:206-213. [PMID: 31454473 PMCID: PMC7285888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Individual health is influenced by multiple, potentially correlated factors including healthcare availability, community context, and socioeconomic factors. To measure the health changes at county-levels across North Dakota, South Dakota, and Minnesota, a measure of relative health, health index, was developed incorporating multiple indicators from domains of health conditions, health behaviors, and social determinants. METHODS We combined data from all 206 counties in the aforementioned three states for the years 2008-2012 from multiple data sources. We performed factor analysis that accounted for a hierarchical structure of the overall health index comprising of 15 indicators. RESULTS A hierarchical structure is identified in which three intermediate factors are connecting the health index with 15 health indicators. The grouping results of the 206 counties based on health index values demonstrate the existence of a gradient in health conditions in the Northern Plains. CONCLUSIONS The health status of urban areas was generally better than that of rural areas in the Northern Plains during this study period. The developed index adds stability to the estimates of the population characteristics, especially in rural, sparsely populated counties.
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Affiliation(s)
- Jing Zhau
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Tess Weber
- Sanford Research, Sioux Falls, South Dakota
| | - Jessica Hanson
- Sanford Research, Sioux Falls, South Dakota
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Morgan Nelson
- Center for Pediatric and Community Research, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota
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