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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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2
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Kaufman CE, Grau L, Begay R, Reid M, Goss CW, Hicken B, Shore JH, O’Connell J. American Indian and Alaska Native veterans in the Indian Health Service: Health status, utilization, and cost. PLoS One 2022; 17:e0266378. [PMID: 35363822 PMCID: PMC8975153 DOI: 10.1371/journal.pone.0266378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 03/20/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Many rural American Indian and Alaska Native (AIAN) veterans receive care from the Indian Health Service (IHS). United States Department of Veterans Affairs (VA) has reimbursement agreements with some IHS facilities and tribal programs and seeks to expand community partnerships in tribal areas, but details of how AIAN veterans use IHS are unknown. We aimed to assess the health status, service utilization patterns, and cost of care of veterans who use IHS. METHODS We used comprehensive and integrated IHS data to compare health status, health service utilization and treatment cost of veterans (n = 12,242) to a matched sample of non-veterans (n = 12,242). We employed logistic, linear, or negative binomial regressions as appropriate, by sex and overall. FINDINGS Compared to non-veterans, veterans had lower odds of having hypertension, renal disease, all-cause dementia, and alcohol or drug use disorders, but had similar burden of other conditions. In service utilization, veterans had lower hospital inpatient days; patterns were mixed across outpatient services. Unadjusted treatment costs for veterans and non-veterans were $3,923 and $4,145, respectively; veteran adjusted treatment costs were statistically lower. Differences in significance by sex were found for health conditions and service use. CONCLUSIONS AIAN veterans, compared to AIAN non-veterans, were not less healthy, nor did they require more intensive or more costly care under IHS. Our results indicate the viability and importance of expanding IHS-VA partnerships in community care.
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Affiliation(s)
- Carol E. Kaufman
- U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Laura Grau
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Rene Begay
- U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Margaret Reid
- Department of Health Services, Management, and Policy, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Cynthia W. Goss
- U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Bret Hicken
- U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America
| | - Jay H. Shore
- U.S. Department of Veterans Affairs (VA), Office of Rural Health (ORH), Veterans Rural Health Resource Center in Salt Lake City, Salt Lake City, UT, United States of America
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
| | - Joan O’Connell
- Centers for American Indian and Alaska Native Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, United States of America
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Harper S, Riddell CA, King NB. Declining Life Expectancy in the United States: Missing the Trees for the Forest. Annu Rev Public Health 2021; 42:381-403. [PMID: 33326297 DOI: 10.1146/annurev-publhealth-082619-104231] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, life expectancy in the United States has stagnated, followed by three consecutive years of decline. The decline is small in absolute terms but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show that the decline has affected nearly all race/ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer's disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.
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Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Corinne A Riddell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California 94720, USA;
| | - Nicholas B King
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec H3A 1A2, Canada; , .,Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A2, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Quebec H3A 1X1, Canada
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O'Connell JM, Rockell JE, Ouellet JC, Yoder S, Lind KE, Wilson C, Friedson A, Manson SM. The Prevalence of Cardiovascular Disease and Other Comorbidities Among American Indian and Alaska Native Adults with Diabetes. EC ENDOCRINOLOGY AND METABOLIC RESEARCH 2021; 6:5-20. [PMID: 34766170 PMCID: PMC8580367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS American Indians and Alaska Native (AI/ANs) peoples experience significant health disparities compared to the U.S. general population. We report comorbidities among AI/ANs with diabetes to guide efforts to improve their health status. METHODS Drawing upon data for over 640,000 AI/ANs who used services funded by the Indian Health Service, we identified 43,518 adults with diabetes in fiscal year 2010. We reported the prevalence of comorbidities by age and cardiovascular disease (CVD) status. Generalized linear models were estimated to describe associations between CVD and other comorbidities. RESULTS Nearly 15% of AI/AN adults had diabetes. Hypertension, CVD and kidney disease were comorbid in 77.9%, 31.6%, and 13.3%, respectively. Nearly 25% exhibited a mental health disorder; 5.7%, an alcohol or drug use disorder. Among AI/ANs with diabetes absent CVD, 46.9% had 2 or more other chronic conditions; the percentage among adults with diabetes and CVD was 75.5%. Hypertension and tobacco use disorders were associated with a 71% (95% CI for prevalence ratio: 1.63 - 1.80) and 33% (1.28 - 1.37) higher prevalence of CVD, respectively, compared to adults without these conditions. CONCLUSION Detailed information on the morbidity burden of AI/ANs with diabetes may inform enhancements to strategies implemented to prevent and treat CVD and other comorbidities.
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Affiliation(s)
- Joan M O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer E Rockell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Telligen, 7730 E Belleview Ave, Suite 300, Greenwood Village, CO, USA
| | - Judith C Ouellet
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | | | - Kimberly E Lind
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Mel & Enid Zuckerman College of Public Health, University of Arizona, USA
| | | | - Andrew Friedson
- Department of Economics, University of Colorado Denver, Denver, Colorado, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Brodt E, Valenzuela S, Empey A, Bruegl A, Spector D, Marino M, Carney PA. Measurement of American Indian and Alaska Native Racial Identity Among Medical School Applicants, Matriculants, and Graduates, 1996-2017. JAMA Netw Open 2021; 4:e2032550. [PMID: 33464317 PMCID: PMC7816107 DOI: 10.1001/jamanetworkopen.2020.32550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022] Open
Abstract
Importance Accurate racial/ethnic identity measurement is needed to understand the effectiveness of outreach, recruitment, and programs to support American Indian and Alaska Native (AIAN) people becoming physicians. Objective To examine how changes in race/ethnicity data collection by the American Medical College Application System are associated with trends in applicants, matriculants, and graduates self-reporting as AIAN. Design, Setting, and Participants In this cohort study, interrupted time series regression was conducted using data from the American Medical College Application system identifying medical school applicants and graduates between January 1, 1996, and December 31, 2017, who identified as AIAN. The number of students identifying as AIAN was compared before and after the American Medical College Application System changed how it collected race/ethnicity data in 2002. Data analyses were conducted between December 2019 and May 2019. Exposures Applicants could select only 1 racial identity from 1996 to 2001 and could select more than 1 racial identity from 2002 to 2017. Main Outcomes and Measures Rates of AIAN groups before and after changing how race/ethnicity data were collected. Covariates were age, sex, and Medical College Admission Test scores. Results The total number of individuals identifying as AIAN in the study was 8361; the mean (SD) number of applicants per year was 380.0 (89.9) overall: 257.3 (39.6) in 1996 to 2001, with a mean (SD) age of 26.6 (5.5) years and 830 (54.0%) male individuals, and 426.1 (50.1) in 2002 to 2017, with a mean (SD) age of 25.5 (5.6) years and 3441 (50.5%) female individuals. Before the change, there was a decrease of 5% per year (relative rate [RR] of 0.95; 95% CI, 0.91-0.98; P < .001) in the rate of AIAN applicants. In 2002, the change in data collection was associated with an immediate 78% relative increase in applicants (RR, 1.78; 95% CI, 1.55-2.06; P < .001). From 2002 to 2017 there was a 10% increase in applicants per year (RR, 1.10; 95% CI, 1.06-1.14; P < .001). For matriculants, yearly trends indicated a nonsignificant 3% decrease before the change, whereas the change was associated with an immediate 62% relative increase in matriculants (RR, 1.62; 95% CI, 1.35-1.95; P < .001), with no difference in trend after the change. For graduates, a nonsignificant yearly decrease of 2% was found in the mean number of graduates before the change, whereas the change was associated with an immediate 94% relative increase (RR, 1.94; 95% CI, 1.57-2.38; P < .001), followed by no change in trend after the modification. Conclusions and Relevance Changing the method of race/ethnicity data collection captured more AIAN applicants, matriculants, and graduates. Yearly trends indicate concerning although nonsignificant differences after the change for AIAN graduates. These findings should inform diversity efforts.
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Affiliation(s)
- Erik Brodt
- Department of Family Medicine, Oregon Health & Science University, Portland
- Ojibwe, Minnesota
| | - Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland
- Omaha Tribe of Nebraska
| | - Allison Empey
- Department of Pediatrics, Oregon Health & Science University, Portland
- Confederated Tribes of Grand Ronde, Oregon
| | - Amanda Bruegl
- Department of Obstetrics-Gynecology, Oregon Health & Science University, Portland
- Oneida and Stockbridge-Munsee Nations, Wisconsin
| | - Dove Spector
- Department of Family Medicine, Oregon Health & Science University, Portland
- Nez Perce Tribe, Idaho
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Biostatistics, Oregon Health & Science University, Portland
- Department of Family Medicine, Portland State University School of Public Health, Portland, Oregon
| | - Patricia A. Carney
- Department of Family Medicine, Oregon Health & Science University, Portland
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Lalla A, Salt S, Schrier E, Brown C, Curley C, Muskett O, Begay MG, Shirley L, Clark C, Singer J, Shin S, Nelson AK. Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation. BMC Health Serv Res 2020; 20:24. [PMID: 31914997 PMCID: PMC6950858 DOI: 10.1186/s12913-019-4839-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).
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Affiliation(s)
- Amber Lalla
- University of New Mexico, 2425 Camino de Salud, Albuquerque, NM 87106 USA
| | - Shine Salt
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | | | - Christian Brown
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Lenora Shirley
- Navajo Nation Community Health Representative & Outreach Program, Navajo Nation Department of Health, Hwy 264 and St. Michael Road, St Michael, AZ 86511 USA
| | - Clarina Clark
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Judy Singer
- Community Outreach and Patient Empowerment (COPE), 210 East Aztec Avenue, Gallup, NM 87301 USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Adrianne Katrina Nelson
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112 USA
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Carney PA, Taylor C, Frutos R, Spector D, Brodt E. Indigenizing Academics Through Leadership, Awareness, and Healing: The Impact of a Native American Health Seminar Series for Health Professionals, Students, and Community. J Community Health 2019; 44:1027-1036. [PMID: 31104200 DOI: 10.1007/s10900-019-00669-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health disparities have long affected American Indian and Alaska Native (AI/AN) populations. Transformations are needed in academia to help understand Indigenous 'ways of knowing.' Lifting the voices of AI/ANs in telling their stories could improve the education of students, faculty and the lay public. We collaborated to develop, implement and evaluate a Native American Health Seminar Series taught by AI/AN leaders on addressing health disparities among AI/AN people. A quasi-experimental mixed methods design included a 15-item survey to assess the impact of the Seminar Series on knowledge of AI/AN health issues and its influence, among students, on health career choices. During the 2018 academic year, three seminars were held and 243 participants attended. In total, 182 surveys (74.9%) were completed by faculty members, students and members of the lay public. Students (all categories combined) represented the highest participant group (48.4%), followed by the lay public at 30% and faculty at 21.6%. The highest scores on knowledge of Native health issues prior to seminar attendance were reported by those representing the lay public with a mean of 3.96 compared to 3.67 for faculty and 3.43 among students (p = 0.01), which was highly represented by Indigenous people. Increases in knowledge occurred in all participant groups. Among students, 65.6% initially indicated that they were not planning on pursuing a career in Native health. Among these, 56.9% indicated they were somewhat to extremely likely to pursue a career in Native health as a result of having attended the seminar.
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Affiliation(s)
- Patricia A Carney
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Cynthia Taylor
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Rosa Frutos
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Dove Spector
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Erik Brodt
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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Brodt E, Bruegl A, Thayer EK, Eiff MP, Gonzales K, Crespo C, Spector D, Kamaka M, Carpenter DA, Carney PA. Concerning trends in allopathic medical school faculty rank for Indigenous people: 2014-2016. MEDICAL EDUCATION ONLINE 2018; 23:1508267. [PMID: 30103656 PMCID: PMC6095016 DOI: 10.1080/10872981.2018.1508267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade. OBJECTIVE To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied. METHODS Data from the Association of American Medical Colleges' Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools. RESULTS The majority of medical school faculty were White, 62.4% (n = 300,642). Asian composition represented 14.7% (n = 70,647). Hispanic, Latino, or of Spanish Origin; Multiple Race-Hispanic; Multiple Race-Non-Hispanic; and Black/African American faculty represented 2.2%, 2.3%, 3.0%, and 3.0%, respectively. Indigenous faculty members, defined as American Indian/Alaska Native (AIAN), Native Hawaiian or Other Pacific Islander (NHPI), represented the smallest percentage of faculty at 0.11% and 0.18%, respectively. White faculty predominated the full professor rank at 27.5% in 2016 with a slight decrease between 2014 and 2016. Indigenous faculty represented the lowest percent of full professor faculty at 5.2% in 2016 for AIAN faculty and a decline from 4.6% to 1.6% between 2014 and 2016 for NHPI faculty (p < 0.001). CONCLUSIONS While US medical school faculty are becoming more racially and ethnically diverse, representation of AIAN faculty is not improving and is decreasing significantly among NHPI faculty. Little progress has been made in eliminating health disparities among Indigenous people. Diversifying the medical workforce could better meet the needs of communities that historically and currently experience a disproportionate disease burden.
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Affiliation(s)
- Erik Brodt
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amanda Bruegl
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Erin K. Thayer
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - M. Patrice Eiff
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kelly Gonzales
- Community Health Program, School of Public Health, Oregon Health & Science and Portland State University, Portland, OR, USA
| | - Carlos Crespo
- Community Health Program, Undergraduate Training Biomedical Research, Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, USA
| | - Dove Spector
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martina Kamaka
- Department of Native Hawaiian Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Dee-Ann Carpenter
- Department of Native Hawaiian Health, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Patricia A. Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Pearson CR, Parker M, Zhou C, Donald C, Fisher CB. A culturally tailored research ethics training curriculum for American Indian and Alaska Native communities: a randomized comparison trial. CRITICAL PUBLIC HEALTH 2018; 29:27-39. [PMID: 30613127 PMCID: PMC6320230 DOI: 10.1080/09581596.2018.1434482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/23/2017] [Indexed: 11/20/2022]
Abstract
The primary aim of this study was to develop an American Indian and Alaska Native (AIAN) tailored research with human subjects curriculum that would increase the participation of AIAN members in research affecting their communities. We used a community-engaged research approach to co-design and evaluate a culturally tailored online human subjects curriculum among a national sample of AIAN community members (n = 244) with a standard nationally used online curriculum (n = 246). We evaluated pre-and post-test measures to assess group differences in ethics knowledge, perceived self-efficacy to apply such knowledge to protocol review, and trust in research. Analysis of regional tribal differences assessed curriculum generalizability. Using an 80% correct item cut-off at first attempt as passing criterion, the tailored curriculum achieved a 59.3% passing rate versus 28.1% in the standard curriculum (p < .001). For both arms, participants reported a significant increase in trust in research and in research review efficacy. Participants took less time to complete the training and reported significantly higher acceptability, satisfaction, and understandability of the curriculum for the tailored curriculum. This culturally tailored research ethics curriculum has the potential to increase participation in AIAN communities in research affecting tribal members. The AIAN curriculum achieved significantly higher levels of participants' research ethics knowledge, self-efficacy in reviewing research protocols, trust in research, and completion of the training requirements. Culturally grounded training curricula may help remedy the impact of historical research ethics abuses involving AIAN communities that have contributed to mistrust of research and lack of community engagement in research.
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Affiliation(s)
- C. R. Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - M. Parker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - C. Zhou
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - C. Donald
- Center for Healthy Communities, Oregon Health & Science University, Portland, OR, USA
| | - C. B. Fisher
- Department of Psychology, Fordham University, Bronx, NY, USA
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10
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Shiels MS, Chernyavskiy P, Anderson WF, Best AF, Haozous EA, Hartge P, Rosenberg PS, Thomas D, Freedman ND, Berrington de Gonzalez A. Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data. Lancet 2017; 389:1043-1054. [PMID: 28131493 PMCID: PMC5388357 DOI: 10.1016/s0140-6736(17)30187-3] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/06/2016] [Accepted: 12/13/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Reduction of premature mortality is a UN Sustainable Development Goal. Unlike other high-income countries, age-adjusted mortality in the USA plateaued in 2010 and increased slightly in 2015, possibly because of rising premature mortality. We aimed to analyse trends in mortality in the USA between 1999 and 2014 in people aged 25-64 years by age group, sex, and race and ethnicity, and to identify specific causes of death underlying the temporal trends. METHODS For this analysis, we used cause-of-death and demographic data from death certificates from the US National Center for Health Statistics, and population estimates from the US Census Bureau. We estimated annual percentage changes in mortality using age-period-cohort models. Age-standardised excess deaths were estimated for 2000 to 2014 as observed deaths minus expected deaths (estimated from 1999 mortality rates). FINDINGS Between 1999 and 2014, premature mortality increased in white individuals and in American Indians and Alaska Natives. Increases were highest in women and those aged 25-30 years. Among 30-year-olds, annual mortality increases were 2·3% (95% CI 2·1-2·4) for white women, 0·6% (0·5-0·7) for white men, and 4·3% (3·5-5·0) and 1·9% (1·3-2·5), respectively, for American Indian and Alaska Native women and men. These increases were mainly attributable to accidental deaths (primarily drug poisonings), chronic liver disease and cirrhosis, and suicide. Among individuals aged 25-49 years, an estimated 111 000 excess premature deaths occurred in white individuals and 6600 in American Indians and Alaska Natives during 2000-14. By contrast, premature mortality decreased substantially across all age groups in Hispanic individuals (up to 3·2% per year), black individuals (up to 3·9% per year), and Asians and Pacific Islanders (up to 2·6% per year), mainly because of declines in HIV, cancer, and heart disease deaths, resulting in an estimated 112 000 fewer deaths in Hispanic individuals, 311 000 fewer deaths in black individuals, and 34 000 fewer deaths in Asians and Pacific Islanders aged 25-64 years. During 2011-14, American Indians and Alaska Natives had the highest premature mortality, followed by black individuals. INTERPRETATION Important public health successes, including HIV treatment and smoking cessation, have contributed to declining premature mortality in Hispanic individuals, black individuals, and Asians and Pacific Islanders. However, this progress has largely been negated in young and middle-aged (25-49 years) white individuals, and American Indians and Alaska Natives, primarily because of potentially avoidable causes such as drug poisonings, suicide, and chronic liver disease and cirrhosis. The magnitude of annual mortality increases in the USA is extremely unusual in high-income countries, and a rapid public health response is needed to avert further premature deaths. FUNDING US National Cancer Institute Intramural Research Program.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Pavel Chernyavskiy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Ana F Best
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Emily A Haozous
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - David Thomas
- Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Rieckmann T, Moore LA, Croy CD, Novins DK, Aarons G. A National Study of American Indian and Alaska Native Substance Abuse Treatment: Provider and Program Characteristics. J Subst Abuse Treat 2016; 68:46-56. [PMID: 27431046 DOI: 10.1016/j.jsat.2016.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/02/2016] [Accepted: 05/23/2016] [Indexed: 11/20/2022]
Abstract
American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time.
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Affiliation(s)
- Traci Rieckmann
- School of Public Health and Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, United States.
| | - Laurie A Moore
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Calvin D Croy
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Douglas K Novins
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Gregory Aarons
- University of California, San Diego School of Medicine, Department of Psychiatry, 9500 Gilman Drive (0812), San Diego, CA 92093, United States
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Schell LM, Gallo MV, Horton HD. Power and pollutant exposure in the context of American Indian health and survival. Ann Hum Biol 2016; 43:107-14. [PMID: 26814777 PMCID: PMC4983444 DOI: 10.3109/03014460.2016.1146333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND American Indians and Alaskan Natives (AI/AN) are a highly diverse group in terms of culture and language, but share a history of oppression and attempted extermination that has left many with a legacy of poverty and poor health. Cultural and biological survival are important issues for many AI/AN groups. METHODS Using US criteria, AI/AN groups are more likely to be poor. The US National Center for Health Statistics reports that US AI/ANs have higher mortality and morbidity rates than the US population. While all groups racially defined by the US National Center for Health Statistics have been experiencing a decline in fertility since 1983, AI/ANs seem to be suffering a substantially greater and earlier decline in fertility. Given the importance of fertility in the survival of AI/AN communities, it is important to identify the source of this decline. RESULTS A recent study of one AI/AN group living along the St. Lawrence River found that obesity and exposure to a particular group of polychlorinated biphenyls were the factors most highly associated with indicators of impaired fertility. Economic factors are often cited as reasons for fertility declines, however in this situation these other factors may have either primary or contributing roles. CONCLUSIONS If the associations with obesity and toxicant exposure are confirmed, intervening on these factors might be important steps in stemming continued declines in fertility.
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Affiliation(s)
- L M Schell
- a Department of Anthropology , University at Albany, SUNY , Albany , NY 12222 , USA
- b Department of Epidemiology and Biostatistics , University at Albany, SUNY , Albany , NY 12222 , USA
- c Center for the Elimination of Minority Health Disparities, University at Albany, SUNY , Albany , NY 12222 , USA
| | - M V Gallo
- a Department of Anthropology , University at Albany, SUNY , Albany , NY 12222 , USA
- c Center for the Elimination of Minority Health Disparities, University at Albany, SUNY , Albany , NY 12222 , USA
| | - H D Horton
- d Department of Sociology , University at Albany, SUNY , Albany , NY 12222 , USA
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Kunitz SJ. Historical Influences on Contemporary Tobacco Use by Northern Plains and Southwestern American Indians. Am J Public Health 2016; 106:246-55. [PMID: 26691134 PMCID: PMC4815564 DOI: 10.2105/ajph.2015.302909] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2015] [Indexed: 11/04/2022]
Abstract
There are great differences in smoking- and tobacco-related mortality between American Indians on the Northern Plains and those in the Southwest that are best explained by (1) ecological differences between the two regions, including the relative inaccessibility and aridity of the Southwest and the lack of buffalo, and (2) differences between French and Spanish Indian relations policies. The consequence was the disruption of inter- and intratribal relations on the Northern Plains, where as a response to disruption the calumet (pipe) ceremony became widespread, whereas it did not in the Southwest. Tobacco was, thus, integrated into social relationships with religious sanctions on the Northern Plains, which increased the acceptability of commercial cigarettes in the 20th century. Smoking is, therefore, more deeply embedded in religious practices and social relationships on the Northern Plains than in the Southwest.
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Affiliation(s)
- Stephen J Kunitz
- Stephen J. Kunitz is with the Division of Social and Behavioral Medicine, Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY
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The Legacy of Uranium Development on or Near Indian Reservations and Health Implications Rekindling Public Awareness. GEOSCIENCES 2015. [DOI: 10.3390/geosciences5010015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Espey DK, Jim MA, Cobb N, Bartholomew M, Becker T, Haverkamp D, Plescia M. Leading causes of death and all-cause mortality in American Indians and Alaska Natives. Am J Public Health 2014; 104 Suppl 3:S303-11. [PMID: 24754554 DOI: 10.2105/ajph.2013.301798] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs). METHODS US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs. RESULTS From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons. CONCLUSIONS AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.
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Affiliation(s)
- David K Espey
- David K. Espey, Melissa A. Jim, Don Haverkamp, and Marcus Plescia are with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Nathaniel Cobb was with and Michael Bartholomew is currently with the Division of Epidemiology and Disease Prevention, Indian Health Service (IHS), Rockville, MD. Tom Becker is with Oregon Health and Sciences University, Portland. David K. Espey is also a guest editor for this supplement issue
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Kunitz SJ, Veazie M, Henderson JA. Historical trends and regional differences in all-cause and amenable mortality among American Indians and Alaska Natives since 1950. Am J Public Health 2014; 104 Suppl 3:S268-77. [PMID: 24754651 DOI: 10.2105/ajph.2013.301684] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
American Indian and Alaska Native (AI/AN) death rates declined over most of the 20th century, even before the Public Health Service became responsible for health care in 1956. Since then, rates have declined further, although they have stagnated since the 1980s. These overall patterns obscure substantial regional differences. Most significant, rates in the Northern and Southern Plains have declined far less since 1949 to 1953 than those in the East, Southwest, or Pacific Coast. Data for Alaska are not available for the earlier period, so its trajectory of mortality cannot be ascertained. Socioeconomic measures do not adequately explain the differences and rates of change, but migration, changes in self-identification as an AI/AN person, interracial marriage, and variations in health care effectiveness all appear to be implicated.
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Affiliation(s)
- Stephen J Kunitz
- At the time this article was written, Stephen J. Kunitz was with the Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY. Mark Veazie was with the Indian Health Service, US Public Health Service, Flagstaff, AZ. Jeffrey A. Henderson was with the Black Hills Center for American Indian Health, Rapid City, SD
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Harris SB, Bhattacharyya O, Dyck R, Hayward MN, Toth EL. Le diabète de type 2 chez les Autochtones. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoover E, Cook K, Plain R, Sanchez K, Waghiyi V, Miller P, Dufault R, Sislin C, Carpenter DO. Indigenous peoples of North America: environmental exposures and reproductive justice. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1645-1649. [PMID: 22899635 DOI: 10.1289/eph.1205422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/16/2012] [Indexed: 05/20/2023]
Abstract
BACKGROUND Indigenous American communities face disproportionate health burdens and environmental health risks compared with the average North American population. These health impacts are issues of both environmental and reproductive justice. OBJECTIVES In this commentary, we review five indigenous communities in various stages of environmental health research and discuss the intersection of environmental health and reproductive justice issues in these communities as well as the limitations of legal recourse. DISCUSSION The health disparities impacting life expectancy and reproductive capabilities in indigenous communities are due to a combination of social, economic, and environmental factors. The system of federal environmental and Indian law is insufficient to protect indigenous communities from environmental contamination. Many communities are interested in developing appropriate research partnerships in order to discern the full impact of environmental contamination and prevent further damage. CONCLUSIONS Continued research involving collaborative partnerships among scientific researchers, community members, and health care providers is needed to determine the impacts of this contamination and to develop approaches for remediation and policy interventions.
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Affiliation(s)
- Elizabeth Hoover
- American Studies Department, Brown University, Providence, Rhode Island 02912 , USA.
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Indigenous peoples of North America: environmental exposures and reproductive justice. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1645-9. [PMID: 22899635 PMCID: PMC3548285 DOI: 10.1289/ehp.1205422] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/16/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Indigenous American communities face disproportionate health burdens and environmental health risks compared with the average North American population. These health impacts are issues of both environmental and reproductive justice. OBJECTIVES In this commentary, we review five indigenous communities in various stages of environmental health research and discuss the intersection of environmental health and reproductive justice issues in these communities as well as the limitations of legal recourse. DISCUSSION The health disparities impacting life expectancy and reproductive capabilities in indigenous communities are due to a combination of social, economic, and environmental factors. The system of federal environmental and Indian law is insufficient to protect indigenous communities from environmental contamination. Many communities are interested in developing appropriate research partnerships in order to discern the full impact of environmental contamination and prevent further damage. CONCLUSIONS Continued research involving collaborative partnerships among scientific researchers, community members, and health care providers is needed to determine the impacts of this contamination and to develop approaches for remediation and policy interventions.
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Food insecurity and household eating patterns among vulnerable American-Indian families: associations with caregiver and food consumption characteristics. Public Health Nutr 2012; 16:752-60. [PMID: 22874098 DOI: 10.1017/s136898001200300x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify factors associated with food insecurity and household eating patterns among American-Indian families with young children. DESIGN Cross-sectional survey among households with young children that were receiving emergency food services. We collected information on food insecurity levels, household eating patterns, experiences with commercial and community food sources and demographics, and used multivariate regression techniques to examine associations among these variables. SETTING Four Southwestern American-Indian reservation communities. SUBJECTS A total of 425 parents/caregivers of young children completed the survey. RESULTS Twenty-nine per cent of children and 45 % of adults from households participating in the survey were classified as 'food insecure'. Larger household size was associated with increased food insecurity and worse eating patterns. Older respondents were more likely than younger respondents to have children with food insecurity (relative risk = 2·19, P < 0·001) and less likely to have healthy foods available at home (relative risk = 0·45, P < 0·01). Consumption of food from food banks, gas station/convenience stores or fast-food restaurants was not associated with food insecurity levels. Respondents with transportation barriers were 1·46 times more likely to be adult food insecure than respondents without transportation barriers (P < 0·001). High food costs were significantly associated with greater likelihoods of adult (relative risk = 1·47, P < 0·001) and child (relative risk = 1·65, P < 0·001) food insecurity. CONCLUSIONS Interventions for American-Indian communities must address challenges such as expense and limited transportation to accessing healthy food. Results indicate a need for services targeted to older caregivers and larger households. Implications for innovative approaches to promoting nutrition among American-Indian communities, including mobile groceries and community gardening programmes, are discussed.
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Brave Heart MYH, Elkins J, Tafoya G, Bird D, Salvador M. Wicasa Was'aka: restoring the traditional strength of American Indian boys and men. Am J Public Health 2012; 102 Suppl 2:S177-83. [PMID: 22401529 DOI: 10.2105/ajph.2011.300511] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We examined health disparities among American Indian men and boys within the framework of historical trauma, which incorporates the historical context of collective massive group trauma across generations. We reviewed the impact of collective traumatic experiences among Lakota men, who have faced cross-generational challenges to enacting traditional tribal roles. We describe historical trauma-informed interventions used with two tribal groups: Lakota men and Southwestern American Indian boys. These two interventions represent novel approaches to addressing historical trauma and the health disparities that American Indians face. We offer public health implications and recommendations for strategies to use in the planning and implementation of policy, research, and program development with American Indian boys and men.
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Affiliation(s)
- Maria Yellow Horse Brave Heart
- Department of Psychiatry, Center for Rural and Community Behavioral Health, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA.
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O'Connell JM, Wilson C, Manson SM, Acton KJ. The costs of treating American Indian adults with diabetes within the Indian Health Service. Am J Public Health 2012; 102:301-8. [PMID: 22390444 PMCID: PMC3483981 DOI: 10.2105/ajph.2011.300332] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the costs of treating American Indian adults with diabetes within the Indian Health Service (IHS). METHODS We extracted demographic and health service utilization data from the IHS electronic medical reporting system for 32 052 American Indian adults in central Arizona in 2004 and 2005. We derived treatment cost estimates from an IHS facility-specific cost report. We examined chronic condition prevalence, medical service utilization, and treatment costs for American Indians with and without diabetes. RESULTS IHS treatment costs for the 10.9% of American Indian adults with diabetes accounted for 37.0% of all adult treatment costs. Persons with diabetes accounted for nearly half of all hospital days (excluding days for obstetrical care). Hospital inpatient service costs for those with diabetes accounted for 32.2% of all costs. CONCLUSIONS In this first study of treatment costs within the IHS, costs for American Indians with diabetes were found to consume a significant proportion of IHS resources. The findings give federal agencies and tribes critical information for resource allocation and policy formulation to reduce and eventually eliminate diabetes-related disparities between American Indians and Alaska Natives and other racial/ethnic populations.
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Affiliation(s)
- Joan M O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
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Probst JC, Bellinger JD, Walsemann KM, Hardin J, Glover SH. Higher Risk Of Death In Rural Blacks And Whites Than Urbanites Is Related To Lower Incomes, Education, And Health Coverage. Health Aff (Millwood) 2011; 30:1872-9. [DOI: 10.1377/hlthaff.2011.0668] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Janice C. Probst
- Janice C. Probst ( ) is a professor in the Department of Health Services Policy and Management in the Arnold School of Public Health, University of South Carolina, and director of the South Carolina Rural Health Research Center, in Columbia
| | - Jessica D. Bellinger
- Jessica D. Bellinger is a research assistant professor in the Department of Health Services Policy and Management at the Arnold School of Public Health
| | - Katrina M. Walsemann
- Katrina M. Walsemann is an assistant professor in the Department of Health Promotion, Education, and Behavior at the Arnold School of Public Health
| | - James Hardin
- James Hardin is the director of the Biostatistics Collaborative Unit at the University of South Carolina and an associate professor in the university’s Department of Epidemiology and Biostatistics
| | - Saundra H. Glover
- Saundra H. Glover is director of the Institute for Health Disparities at the University of South Carolina, associate dean for health disparities and social justice in the university’s Arnold School of Public Health, and associate director of the South Carolina Rural Health Research Center
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Gryczynski J, Johnson JL. Challenges in public health research with American Indians and other small ethnocultural minority populations. Subst Use Misuse 2011; 46:1363-71. [PMID: 21810071 DOI: 10.3109/10826084.2011.592427] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.
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Affiliation(s)
- Jan Gryczynski
- Friends Research Institute, Baltimore, Maryland 21201, USA.
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Garrison ER, Bauer MC, Hosley BL, Patten CA, Hughes CA, Trapp MA, Petersen WO, Austin-Garrison MA, Bowman CN, Vierkant RA. Development and pilot evaluation of a cancer-focused summer research education program for [corrected] Navajo undergraduate students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2010; 25:650-8. [PMID: 20411446 PMCID: PMC2992578 DOI: 10.1007/s13187-010-0118-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/01/2010] [Indexed: 05/11/2023]
Abstract
This paper describes the development and pilot testing of a 10-week cancer research education program for Navajo undergraduate students. The program was piloted at Diné College with 22 undergraduates (7 men, 15 women) in 2007 and 2008. Students completed a pre-post program survey assessing attitudes, opinions, and knowledge about research and about cancer. The program was found to be culturally acceptable and resulted in statistically significant changes in some of the attitudes and opinions about research and cancer. Combining all 13 knowledge items, there was a significant (p = 0.002) change in the mean total correct percent from baseline [70.3 (SD = 15.9)] to post-program [82.1 (SD = 13.1)]. The curriculum was adapted for a new cancer prevention and control course now offered at Diné College, enhancing sustainability. Ultimately, these efforts may serve to build capacity in communities by developing a cadre of future Native American scientists to develop and implement cancer research.
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State political cultures and the mortality of African Americans and American Indians. Health Place 2010; 16:558-66. [DOI: 10.1016/j.healthplace.2010.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/24/2010] [Accepted: 02/03/2010] [Indexed: 11/21/2022]
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Naqshbandi M, Harris SB, Esler JG, Antwi-Nsiah F. Global complication rates of type 2 diabetes in Indigenous peoples: A comprehensive review. Diabetes Res Clin Pract 2008; 82:1-17. [PMID: 18768236 DOI: 10.1016/j.diabres.2008.07.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE The world's Indigenous peoples are experiencing an unprecedented epidemic of type 2 diabetes [T2DM] but little has been published describing the complications burden. The objective of this paper was to conduct a systematic review of T2DM complications in Indigenous populations worldwide. METHODS A literature review was conducted using PubMed and EMBASE to examine available complications data. Country, Indigenous population, authors, publication year, total sample size, Indigenous sample size, age, methodology, and prevalence of nephropathy, end-stage renal disease, retinopathy, neuropathy, lower extremity amputations, cardiovascular disease, hospitalizations and mortality due to diabetes were recorded. RESULTS One-hundred and eleven studies were selected. Results revealed a disproportionate burden of disease complications among all Indigenous peoples regardless of their geographic location. Complication rates were seen to vary widely across Indigenous groups. DISCUSSION Gaps were found in the published literature on complications among Indigenous populations, especially those living in underdeveloped countries. These gaps may be in part due to the challenges caused by varying operational practices, research methodologies, and definitions of the term Indigenous, making documentation of rates among these peoples problematic. Comprehensive surveillance applying standardized definitions and methodologies is needed to design targeted prevention and disease management strategies for Indigenous peoples with T2DM.
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Affiliation(s)
- Mariam Naqshbandi
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Suite 245-100 Collip Circle, London, Ontario, Canada N6G 4X8
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