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Gonuguntla K, Badu I, Duhan S, Sandhyavenu H, Chobufo MD, Taha A, Thyagaturu H, Sattar Y, Keisham B, Ali S, Khan MZ, Latchana S, Naeem M, Shaik A, Balla S, Gulati M. Sex and Racial Disparities in Proportionate Mortality of Premature Myocardial Infarction in the United States: 1999 to 2020. J Am Heart Assoc 2024; 13:e033515. [PMID: 38842272 DOI: 10.1161/jaha.123.033515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The incidence of premature myocardial infarction (PMI) in women (<65 years and men <55 years) is increasing. We investigated proportionate mortality trends in PMI stratified by sex, race, and ethnicity. METHODS AND RESULTS CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths within the United States between 1999 and 2020, and trends in proportionate mortality of PMI were calculated using the Joinpoint regression analysis. We identified 3 017 826 acute myocardial infarction deaths, with 373 317 PMI deaths corresponding to proportionate mortality of 12.5% (men 12%, women 14%). On trend analysis, proportionate mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 (average annual percent change of 1.0 [0.8-1.2, P <0.01]) with a significant increase in women from 10% in 1999 to 17% in 2020 (average annual percent change of 2.4 [1.8-3.0, P <0.01]) and no significant change in men, 11% in 1999 to 10% in 2020 (average annual percent change of -0.2 [-0.7 to 0.3, P=0.4]). There was a significant increase in proportionate mortality in both Black and White populations, with no difference among American Indian/Alaska Native, Asian/Pacific Islander, or Hispanic people. American Indian/Alaska Natives had the highest PMI mortality with no significant change over time. CONCLUSIONS Over the last 2 decades, there has been a significant increase in the proportionate mortality of PMI in women and the Black population, with persistently high PMI in American Indian/Alaska Natives, despite an overall downtrend in acute myocardial infarction-related mortality. Further research to determine the underlying cause of these differences in PMI mortality is required to improve the outcomes after acute myocardial infarction in these populations.
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Affiliation(s)
| | - Irisha Badu
- Department of Medicine Onslow Memorial Hospital Jacksonville NC
| | - Sanchit Duhan
- Department of Medicine Sinai Hospital of Baltimore Baltimore MD
| | | | | | - Amro Taha
- Department of Medicine Weiss Memorial Hospital Chicago IL
| | | | - Yasar Sattar
- Department of Cardiology West Virginia University Morgantown WV
| | - Bijeta Keisham
- Department of Medicine Sinai Hospital of Baltimore Baltimore MD
| | - Shafaqat Ali
- Department of Internal Medicine Louisiana State University Shreveport LA
| | | | - Sharaad Latchana
- American University of Integrative Sciences School of Medicine Bridgetown Barbados
| | - Minahil Naeem
- Department of Internal Medicine King Edward Medical University Lahore Pakistan
| | - Ayesha Shaik
- Department of Cardiology Hartford Hospital Hartford CT
| | - Sudarshan Balla
- Department of Cardiology West Virginia University Morgantown WV
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center Smidt Heart Institute, Cedars Sinai Medical Center Los Angeles CA
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Goldman N, Park SS, Beltrán-Sánchez H. Life expectancy among Native Americans during the COVID-19 pandemic: estimates, uncertainty, and obstacles. Am J Epidemiol 2024; 193:846-852. [PMID: 38140861 PMCID: PMC11145904 DOI: 10.1093/aje/kwad244] [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: 08/22/2023] [Revised: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Few reliable estimates have been available for assessing the impact of the COVID-19 pandemic on mortality among Native Americans. Using deidentified publicly available data on deaths and populations by age, we estimated life expectancy for the years 2019-2022 for single-race non-Hispanic Native Americans. Life expectancy in 2022 was 67.8 years, 2.3 years higher than in 2021 but a huge 4-year loss from 2019. Although our life expectancy estimates for 2022 varied under different assumptions about racial/ethnic classification and age misreporting errors, all estimates were lower than the average for middle-income countries. Estimates of losses and gains in life expectancy were consistent across assumptions. Large reductions in COVID-19 death rates between 2021 and 2022 were largely offset by increases in rates of death from unintentional injuries (particularly drug overdoses), chronic liver disease, diabetes, and heart disease, underscoring the difficulties facing Native Americans in achieving reductions in mortality, let alone returning to levels of mortality prior to the pandemic. Serious data problems have persisted for many years, but the scarcity and inadequacy of estimates during the pandemic have underscored the urgent need for timely and accurate demographic data on the Native American population.
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Affiliation(s)
- Noreen Goldman
- Corresponding author: Noreen Goldman, Office of Population Research and Princeton School of Public and International Affairs, 243 Wallace Hall, Princeton University, Princeton, NJ 08544 ()
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Aboona MB, Faulkner C, Rangan P, Ng CH, Huang DQ, Muthiah M, Nevah Rubin MI, Han MAT, Fallon MB, Kim D, Chen VL, Wijarnpreecha K. Disparities among ethnic groups in mortality and outcomes among adults with MASLD: A multicenter study. Liver Int 2024; 44:1316-1328. [PMID: 38407554 DOI: 10.1111/liv.15880] [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: 09/18/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease and 10%-20% occurs in lean individuals. There is little data in the literature regarding outcomes in an ethnically-diverse patient populations with MASLD. Thus, we aim to investigate the natural history and ethnic disparities of MASLD patients in a diverse population, and stratified by body mass index categories. METHODS We conducted a retrospective multicenter study on patients with MASLD at the Banner Health System from 2012 to 2022. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease, diabetes mellitus (DM), liver-related events (LREs), and cancer. We used competing risk and Cox proportional hazard regression analysis for outcome modelling. RESULTS A total of 51 452 (cross-sectional cohort) and 37 027 (longitudinal cohort) patients were identified with 9.6% lean. The cohort was 63.33% European ancestry, 27.96% Hispanic ancestry, 3.45% African ancestry, and 2.31% Native American/Alaskan ancestry. Median follow-up was 45.8 months. After adjusting for confounders, compared to European individuals, Hispanic and Native American/Alaskan patients had higher prevalence of cirrhosis and DM, and individuals of Hispanic, African, and Native American/Alaskan ancestry had higher mortality and incidence of LREs and DM. Lean patients had higher mortality and incidence of LREs compared with non-lean patients. CONCLUSION Native American/Alaskan, Hispanic, and African patients had higher mortality and incidence of LREs and DM compared with European patients. Further studies to explore the underlying disparities and intervention to prevent LREs in lean patients, particularly several ethnic groups, may improve clinical outcomes.
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Affiliation(s)
- Majd B Aboona
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Claire Faulkner
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Pooja Rangan
- Division of Clinical Data Analytics and Decision Support, Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Cheng Han Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Muthiah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Moises I Nevah Rubin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ma Ai Thanda Han
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Michael B Fallon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Medicine, BIO5 Institute, University of Arizona College of Medicine, Phoenix, Arizona, USA
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4
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Ross K, Schell L, Hubicki L. American Indian/Alaskan Native Child and Adolescent Mortality. J Racial Ethn Health Disparities 2024; 11:1660-1671. [PMID: 37233910 DOI: 10.1007/s40615-023-01641-2] [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] [Received: 01/10/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
The American Indian/Alaskan Native (AI/AN) population experiences substantial health disparities, but the extent is not well characterized especially among children and adolescents. In data from the National Center for Health Statistics, AI/AN persons are often not recognized as such on death certificates. As AI/AN deaths are undercounted, racial/ethnic comparisons showing greater death rates among AI/AN are "Estimates of Minimal Difference" (EMD): the difference in rates between groups that is an estimate of the minimal difference. It is the minimal difference because that difference would only be increased by more accurate race/ethnic classification on certificates as more AI/AN individuals would be counted as such. We compare rates of non-Hispanic AI/AN leading causes of death to non-Hispanic White (n-HW) and non-Hispanic Black (n-HB) children and adolescents using annual reports for "Deaths: Leading Causes" from 2015 to 2017 from the National Vital Statistics System. Among AI/AN 1-19 year-olds, suicide deaths are significantly higher (p<0.00001) than among n-HB (OR=4.34; CI=3.68-5.1) and n-HWs (p<0.007; OR=1.23; CI=1.05-1.42); deaths from accidents are significantly higher (p<0.001) than among n-HB (OR=1.71; CI=1.49-1.93); and deaths due to assault (homicide) are significantly higher (p<0.00002) than among n-HWs (OR=1.64; CI=1.3-2.05). The appearance of suicide as a leading cause of death among AI/AN children and adolescents occurs in the 10-14-year age group and is significantly more common in the 15-19-year age group compared to both n-HB (p<0.00001; OR=5.35; CI=4.40-6.48) and n-HW (p=0.00064; OR=1.36; CI=1.14-1.63). Even without adjusting for undercounting, EMDs show that there are significant health disparities for preventable deaths of AI/AN children and adolescents to be addressed by public health policy.
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Affiliation(s)
- Kayleigh Ross
- Albany Medical College, Albany, NY, USA
- State University of New York at Albany, Albany, NY, USA
| | - Lawrence Schell
- Department of Anthropology and Department of Epidemiology & Biostatistics, State University of New York at Albany, Albany, NY, USA.
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5
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Niu X, Chang J, Corrada MM, Bullock A, Winchester B, Manson SM, O’Connell J, Jiang L. The Relationship between All-Cause Dementia and Acute Diabetes Complications among American Indian and Alaska Native Peoples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:496. [PMID: 38673407 PMCID: PMC11049920 DOI: 10.3390/ijerph21040496] [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] [Received: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND American Indian and Alaska Native people (AI/AN) bear a disproportionate burden of diabetes. Growing evidence shows significant associations between several acute diabetes complications and dementia among diabetes patients. However, little is known about these relationships among AI/AN adults. Here, we aim to investigate these associations among AI/AN adults. METHODS This cross-sectional study extracted data from the Indian Health Service's (IHS) National Data Warehouse and related administrative databases. A total of 29,337 IHS actual users with diabetes who were 45+ years old during fiscal year 2013 were included. All-cause dementia and diabetes complications were identified using ICD-9 diagnostic codes. Negative binomial regression models were used to evaluate the associations of interest. RESULTS Nearly 3% of AI/AN diabetes patients had a dementia diagnosis. After controlling for covariates, dementia was associated with a 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50-2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11-2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53-2.41). CONCLUSIONS AI/AN diabetes patients with dementia suffered from considerably higher rates of acute diabetes complications than their counterparts without dementia. The clinical management of patients with comorbid diabetes and dementia is particularly challenging and may require individualized treatment approaches.
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Affiliation(s)
- Xiaoyi Niu
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
| | - Jenny Chang
- Department of Medicine, University of California Irvine, Irvine, CA 92697, USA;
| | - Maria M. Corrada
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
- Department of Neurology, School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Ann Bullock
- Formerly with the Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD 20857, USA;
| | | | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Joan O’Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.M.M.); (J.O.)
| | - Luohua Jiang
- Department of Epidemiology & Biostatistics, University of California Irvine, Irvine, CA 92697, USA; (X.N.); (M.M.C.)
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Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA. Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study. Chest 2024; 165:716-724. [PMID: 37898186 DOI: 10.1016/j.chest.2023.10.025] [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] [Received: 04/04/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. RESEARCH QUESTION How do American Indian and Alaska Native adults perceive and use lung cancer screening? STUDY DESIGN AND METHODS We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. RESULTS Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. INTERPRETATION Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.
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Affiliation(s)
- Allison C Welch
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Candice L Wilshire
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Gary Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Cole Allick
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Jed A Gorden
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.
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Springer YP, Kammerer JS, Felix D, Newell K, Tompkins ML, Allison J, Castrodale LJ, Chandler B, Helfrich K, Rothoff M, McLaughlin JB, Silk BJ. Using Geographic Disaggregation to Compare Tuberculosis Epidemiology Among American Indian and Alaska Native Persons-USA, 2010-2020. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01919-z. [PMID: 38334874 DOI: 10.1007/s40615-024-01919-z] [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: 10/12/2023] [Revised: 12/29/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND American Indian and Alaska Native (AIAN) populations are frequently associated with the highest rates of tuberculosis (TB) disease of any racial/ethnic group in the USA. We systematically investigated variation in patterns and potential drivers of TB epidemiology among geographically distinct AIAN subgroups. METHODS Using data reported to the National Tuberculosis Surveillance System during 2010-2020, we applied a geographic method of data disaggregation to compare annual TB incidence and the frequency of TB patient characteristics among AIAN persons in Alaska with AIAN persons in other states. We used US Census data to compare the prevalence of substandard housing conditions in AIAN communities in these two geographic areas. RESULTS The average annual age-adjusted TB incidence among AIAN persons in Alaska was 21 times higher than among AIAN persons in other states. Compared to AIAN TB patients in other states, AIAN TB patients in Alaska were associated with significantly higher frequencies of multiple epidemiologic TB risk factors (e.g., attribution of TB disease to recent transmission, previous diagnosis of TB disease) and significantly lower frequencies of multiple clinical risk factors for TB disease (e.g., diagnosis with diabetes mellitus, end-stage renal disease). Occupied housing units in AIAN communities in Alaska were associated with significantly higher frequencies of multiple measures of substandard housing conditions compared to AIAN communities in other states. CONCLUSIONS Observed differences in patient characteristics and substandard housing conditions are consistent with contrasting syndromes of TB epidemiology in geographically distinct AIAN subgroups and suggest ways that associated public health interventions could be tailored to improve efficacy.
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Affiliation(s)
- Yuri P Springer
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA.
| | - J Steve Kammerer
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
| | - Derrick Felix
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
| | - Katherine Newell
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA, USA
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Megan L Tompkins
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Jamie Allison
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Louisa J Castrodale
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Bruce Chandler
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Kathryn Helfrich
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Michelle Rothoff
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Joseph B McLaughlin
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Benjamin J Silk
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
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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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Malika N, Palimaru AI, Rodriguez A, Brown R, Dickerson DL, Holmes P, Kennedy DP, Johnson CL, Sanchez VA, Schweigman K, Klein DJ, D’Amico EJ. Voices of Identity: Exploring Identity Development and Transformation among Urban American Indian/Alaska Native Emerging Adults. IDENTITY (MAHWAH, N.J.) 2024; 24:112-138. [PMID: 38699070 PMCID: PMC11064810 DOI: 10.1080/15283488.2023.2300075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Emerging adulthood shapes personal, professional, and overall well-being through identity exploration. This study addresses a gap in the minority identity literature by investigating how urban AI/AN emerging adults think about their identity and discussing challenges and protective factors associated with exploring their identity holistically. This mixed-methods study created a sampling framework based on discrimination experiences, cultural identity, social network support, mental health, and problematic substance use. We recruited 20 urban AI/AN emerging adults for interviews. We sought to gain deeper insights into their experiences and discussions surrounding identity formation and exploration. We provide descriptives for demographic characteristics and conducted a thematic analysis of the qualitative data from the interviews. Four themes emerged: a) being an urban AI/AN emerging adult means recognizing that one's identity is multifaceted; b) a multifaceted identity comes with tension of living in multiple worlds; c) the trajectory of one's identity grows over time to a deeper desire to connect with Native American culture; and d) understanding one's Native American background affects one's professional trajectory. Findings underscore the importance of developing programs to support well-being and identity development through cultural connection for urban AI/AN emerging adults.
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Affiliation(s)
| | | | | | - Ryan Brown
- RAND Corporation, Santa Monica, California, USA
| | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine
| | | | | | - Carrie L. Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, California, United States
| | | | - Kurt Schweigman
- Public Health Consultant, Santa Rosa, California, United States
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Gartner DR, Maples C, Nash M, Howard-Bobiwash H. Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices. Epidemiol Rev 2023; 45:63-81. [PMID: 37022309 DOI: 10.1093/epirev/mxad001] [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: 07/01/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.
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Affiliation(s)
- Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Ceco Maples
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Madeline Nash
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Heather Howard-Bobiwash
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
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Dang JHT, Chen S, Hall S, Campbell JE, Chen MS, Doescher MP. Tobacco and marijuana use during the COVID-19 pandemic lockdown among American Indians residing in California and Oklahoma. Tob Induc Dis 2023; 21:171. [PMID: 38125581 PMCID: PMC10731663 DOI: 10.18332/tid/174819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION American Indian (AI) people experience a disproportionate tobacco and marijuana burden which may have been exacerbated by the COVID-19 pandemic. Little is known about the tobacco and marijuana habits of American Indian individuals during the COVID-19 pandemic. The objective of this study is to examine tobacco and marijuana use as well as change in use during the COVID-19 pandemic among the American Indian community. METHODS This cross-sectional study analyzes survey data from a convenience sample of American Indian individuals residing in California and Oklahoma and included adults with and without cancer that resided in both rural and urban areas (n=1068). RESULTS During October 2020 - January 2021, 36.0% of participants reported current use of tobacco products, 9.9% reported current use of marijuana products, and 23.7% reported increased use of tobacco and/or marijuana in the past 30 days, with no difference between those with cancer and those without cancer. Tobacco use was associated with marital status, age, employment status, COVID-19 exposure, COVID-19 beliefs, and alcohol consumption. Marijuana use was associated with COVID-19 beliefs, alcohol consumption, and income level. Increased tobacco and/or marijuana use was associated with baseline use of those products. Nearly a quarter of participants reported increased use of tobacco and/or marijuana products during the COVID-19 pandemic. CONCLUSIONS We observed high rates of tobacco use during the COVID-19 pandemic, consistent with other studies. Research is needed to examine whether tobacco and marijuana use will decrease to pre-pandemic levels post-pandemic or if these behaviors will persist post-pandemic. Given these findings, there is a pressing need to increase access to evidence-based tobacco and marijuana treatment services in the AI population post COVID-19 pandemic.
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Affiliation(s)
- Julie H T Dang
- Division of Health Policy and Management, Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, United States
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, United States
| | - Spencer Hall
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, United States
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, United States
| | - Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, United States
| | - Mark P Doescher
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma College of Health Science Center, Oklahoma City, United States
- Stephenson Cancer Center, Oklahoma City, United States
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12
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John-Henderson NA, Ginty AT. Profiles of historical loss and childhood trauma as predictors of mental and cardiometabolic health in American Indian adults. SSM - MENTAL HEALTH 2023; 4:100252. [PMID: 38188870 PMCID: PMC10769154 DOI: 10.1016/j.ssmmh.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Cardiometabolic disease and mental health conditions are two major contributors to persistent inequities in health and life expectancy for American Indian adults. The atrocities associated with European colonization are linked to intergenerational psychological and emotional wounding (i.e., historical trauma) and high incidence of childhood trauma. Prior work has examined the independent relationships of childhood trauma and thoughts about historical loss with cardiometabolic and mental health in American Indians. In the current work, we used a data-driven approach to identify profiles of childhood trauma and frequency of thoughts about historical loss, and then examined how these profiles related to cardiometabolic and mental health in a sample of American Indian adults from across the United States (N = 727). We found that a profile characterized by high levels of childhood trauma and high frequency of thoughts about historical losses was associated with the greatest risk for mental health conditions. The profile characterized by the highest levels of childhood trauma and by moderate frequency of thoughts about historical losses was associated with the largest risk of cardiometabolic conditions. The findings represent an important first step towards understanding how childhood trauma and thoughts about historical loss may simultaneously inform enduring inequities in American Indian health.
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Affiliation(s)
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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13
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John-Henderson NA, White EJ, Crowder TL. Resilience and health in American Indians and Alaska Natives: A scoping review of the literature. Dev Psychopathol 2023; 35:2241-2252. [PMID: 37345444 PMCID: PMC10739606 DOI: 10.1017/s0954579423000640] [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: 06/23/2023]
Abstract
American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.
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Affiliation(s)
- Neha A John-Henderson
- Department of Psychology, Montana State University, Bozeman, MT, USA
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Tony L Crowder
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
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14
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Lewis ME, Wildcat S, Anderson A. Visioning an Effective Health Encounter: Indigenous Healthcare Experiences and Recommendations for Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6917. [PMID: 37887655 PMCID: PMC10606678 DOI: 10.3390/ijerph20206917] [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] [Received: 03/02/2023] [Revised: 09/05/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Indigenous patients experience challenges while accessing and utilizing healthcare services that relate to worsened health experiences. Bias towards Indigenous patients is prevalent in healthcare settings and leads to poor health outcomes. The purpose of this study was to learn about the healthcare experiences, both positive and negative, of Indigenous patients and solicit subsequent recommendations to improve care delivered to this population. METHODS This study sampled Indigenous patients (n = 20) from an Indigenous-serving health clinic to discuss participants' health experiences and elicit recommendations for improved care. Four focus groups were conducted, and template analysis was employed to analyze the data. RESULTS A total of 15 themes were developed under the category of an effective health encounter. Highlighted themes include healthcare that is free of stigma, quality care, respecting trauma experiences, expanded integrated care and the patient-provider relationship. Based on participant recommendations, a checklist was created for healthcare professionals to improve care delivery to Indigenous patients. Results indicated that bias in healthcare settings may masquerade as poor clinical care but is really founded in biased beliefs and healthcare delivery. Alternatively, when patients received good quality care, their healthcare outcomes improved. Further, effective healthcare incorporates culture, family, tribe, and community and addresses these aspects of health in both clinical and systemic settings. CONCLUSIONS With some of the largest proportions of health disparities and bias experiences in the US, it is critical that healthcare delivered to Indigenous patients incorporate culturally safe care to regain dignity and improve health outcomes for this population.
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Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO 65201, USA
| | - Sky Wildcat
- Department of Higher Education, College of Education and Health Professions, University of Arkansas, Fayetteville, AR 72701, USA
| | - Amber Anderson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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15
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Reece J, Skelton-Wilson S, Mitchell-Box K, Groom A, Thomas C. Building a Roadmap to Health Equity: Strengthening Public Health Infrastructure in Indian Country. Public Health Rep 2023; 138:7S-13S. [PMID: 37565292 PMCID: PMC10515983 DOI: 10.1177/00333549231186579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Affiliation(s)
- Julianna Reece
- Division of Population Health, Centers for Disease Control and Prevention, Albuquerque, NM, USA
| | | | - Kristen Mitchell-Box
- Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center, Anchorage, AK, USA
| | - Amy Groom
- Healthy Tribes, Centers for Disease Control and Prevention, Albuquerque, NM, USA
| | - Craig Thomas
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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16
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Sehar U, Kopel J, Reddy PH. Alzheimer's disease and its related dementias in US Native Americans: A major public health concern. Ageing Res Rev 2023; 90:102027. [PMID: 37544432 PMCID: PMC10515314 DOI: 10.1016/j.arr.2023.102027] [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: 05/08/2023] [Revised: 07/25/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's related dementias (ADRD) are growing public health concerns in aged populations of all ethnic and racial groups. AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Studies of postmortem brains have revealed multiple cellular changes implicated in AD and ADRD, including the accumulation of amyloid beta and phosphorylated tau, synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss. These changes occur in both early-onset familial and late-onset sporadic forms. Two-thirds of women and one-third of men are at life time risk for AD. A small proportion of total AD cases are caused by genetic mutations in amyloid precursor protein, presenilin 1, and presenilin 1 genes, and the APOE4 allele is a risk factor. Tremendous research on AD/ADRD, and other comorbidities such as diabetes, obesity, hypertension, and cancer has been done on almost all ethnic groups, however, very little biomedical research done on US Native Americans. AD/ADRD prevalence is high among all ethnic groups. In addition, US Native Americans have poorer access to healthcare and medical services and are less likely to receive a diagnosis once they begin to exhibit symptoms, which presents difficulties in treating Alzheimer's and other dementias. One in five US Native American people who are 45 years of age or older report having memory issues. Further, the impact of caregivers and other healthcare aspects on US Native Americans is not yet. In the current article, we discuss the history of Native Americans of United States (US) and health disparities, occurrence, and prevalence of AD/ADRD, and shedding light on the culturally sensitive caregiving practices in US Native Americans. This article is the first to discuss biomedical research and healthcare disparities in US Native Americans with a focus on AD and ADRD, we also discuss why US Native Americans are reluctant to participate in biomedical research.
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Affiliation(s)
- Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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17
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Lee YS, Roh S, Hsieh YP, Park Y. Determinants of Life Satisfaction and Quality of Life Among American Indian Women Cancer Survivors: The Role of Psychosocial Resources. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:536-555. [PMID: 37330683 DOI: 10.1080/26408066.2023.2185561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This study assessed the relationship of spirituality, social support, and sense of mastery to life satisfaction and quality of life to identify viable psychosocial coping resources among American Indian (AI) women cancer survivors. METHOD We conducted a cross-sectional survey of 73 AI women cancer survivors residing in South Dakota. A series of multivariate hierarchical regression analyses was conducted. RESULTS Findings indicated that lower self-rated physical health was consistently associated with lower levels of life satisfaction and quality of life. Spirituality was found to be the most influential predictor for life satisfaction, while social support and sense of mastery were two significant predictors for quality of life. DISCUSSION Our data underscored the importance of spirituality, social support, and sense of mastery to the well-being of AI women cancer survivors and as effective coping strategies to mitigate life stressors. Implications of this evidence for the design of cancer preventions and interventions are discussed.
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Affiliation(s)
- Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, United States
| | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, South Dakota, United States
| | - Yi-Ping Hsieh
- Department of Social Work, University of North Dakota, Grand Forks, North Dakota, United States
| | - Yeddi Park
- Department of Family Therapy and Social Work, Fairfield University, Connecticut, United States
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18
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Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2023; 19:341-352. [PMID: 36170116 PMCID: PMC10316527 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
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Affiliation(s)
| | - Margaret M. Reid
- Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Jenny J. Chang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y. Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M. Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R. Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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19
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Mehta LS, Velarde GP, Lewey J, Sharma G, Bond RM, Navas-Acien A, Fretts AM, Magwood GS, Yang E, Blumenthal RS, Brown RM, Mieres JH. Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association. Circulation 2023; 147:1471-1487. [PMID: 37035919 PMCID: PMC11196122 DOI: 10.1161/cir.0000000000001139] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Cardiovascular disease is the leading cause of death in women, yet differences exist among certain racial and ethnic groups. Aside from traditional risk factors, behavioral and environmental factors and social determinants of health affect cardiovascular health and risk in women. Language barriers, discrimination, acculturation, and health care access disproportionately affect women of underrepresented races and ethnicities. These factors result in a higher prevalence of cardiovascular disease and significant challenges in the diagnosis and treatment of cardiovascular conditions. Culturally sensitive, peer-led community and health care professional education is a necessary step in the prevention of cardiovascular disease. Equitable access to evidence-based cardiovascular preventive health care should be available for all women regardless of race and ethnicity; however, these guidelines are not equally incorporated into clinical practice. This scientific statement reviews the current evidence on racial and ethnic differences in cardiovascular risk factors and current cardiovascular preventive therapies for women in the United States.
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20
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Meza R, Cao P, Jeon J, Fleischer NL, Holford TR, Levy DT, Tam J. Patterns of Birth Cohort‒Specific Smoking Histories by Race and Ethnicity in the U.S. Am J Prev Med 2023; 64:S11-S21. [PMID: 36653232 PMCID: PMC10362802 DOI: 10.1016/j.amepre.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION U.S. smoking prevalence varies greatly by race/ethnicity. However, little is known about how smoking initiation, cessation, and intensity vary by birth cohort and race/ethnicity. METHODS Adult smoking data were obtained from the 1978-2018 National Health Interview Surveys. Age‒period‒cohort models with constrained natural splines were developed to estimate historical smoking patterns among non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian and Pacific Islander, and non-Hispanic American Indian and Alaskan Native individuals. Annual smoking prevalence and probabilities of smoking initiation, cessation, and intensity by age, year, gender, and race/ethnicity were estimated for the 1900 to 2000 birth cohorts. Analysis was conducted in 2020-2021. RESULTS Smoking initiation probabilities were highest for the American Indian and Alaskan Native population, second highest among the non-Hispanic White population, and lowest among Asian and Pacific Islander and Hispanic populations across birth cohorts. Historically, initiation probabilities among non-Hispanic Black populations were comparable with those among non-Hispanic White populations but have decreased since the 1970 birth cohort. Cessation probabilities were lowest among American Indian and Alaskan Native and non-Hispanic Black populations and highest among non-Hispanic White and Asian and Pacific Islander populations across cohorts and ages. Initiation and cessation probabilities produce observed patterns of smoking where prevalence among American Indian and Alaskan Native populations is highest across all ages and cohorts. Across cohorts, smoking prevalence among non-Hispanic Black populations, particularly males, is lower than among non-Hispanic White populations at younger ages but higher at older ages. CONCLUSIONS There are important and persistent racial/ethnic differences in smoking prevalence, initiation, cessation, and intensity across U.S. birth cohorts. Targeted interventions should address widening smoking disparities by race/ethnicity, particularly for American Indian and Alaskan Native and non-Hispanic Black populations.
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Affiliation(s)
- Rafael Meza
- From the Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - David T Levy
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Jamie Tam
- and the Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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21
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McCullen JR, Counts CJ, John-Henderson NA. Childhood adversity and emotion regulation strategies as predictors of psychological stress and mental health in American Indian adults during the COVID-19 pandemic. Emotion 2023; 23:805-813. [PMID: 35951388 PMCID: PMC9918611 DOI: 10.1037/emo0001106] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Life events, such as the Coronavirus disease 2019 (COVID-19) pandemic, elicit increases in psychological stress and symptoms of anxiety and depression. In turn, these outcomes have negative implications for mental health. Emotion regulation strategies and prior adversity may moderate the degree to which life events affect outcomes that are linked to mental health. The purpose of the current study was to evaluate whether childhood adversity and emotion regulation strategy use interactively informed changes in outcomes linked to mental health following the onset of the pandemic in American Indian (AI) adults. AI adults (N = 210) reported levels of childhood adversity, emotion regulation strategy use, symptoms of anxiety and depression, and psychological stress 1 month prior to the onset of the COVID-19 pandemic. One month following the declaration of the pandemic, they reported on their stress, symptoms of anxiety and depression once again. The interaction between expressive suppression and childhood adversity predicted changes in psychological stress and symptoms of depression (B = .26, t(198) = 4.43 p < .001, R² change = .06) and (B = .23 t(199) = 4.14, p < .001, R² change = .05) respectively. The findings indicate that expressive suppression may be a maladaptive emotion regulation strategy for AI adults who experienced high levels of childhood adversity. This work represents a first step in understanding the role of emotion regulation strategy use in predicting mental health-relevant outcomes in the context of a life event, in a community that is disproportionately affected by chronic mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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22
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Grant V, Mekiana D, Philip J. Physical Activity, Sleep, and Demographic Patterns in Alaska Native Children and Youth Living in Anaktuvuk Pass. YOUTH (BASEL, SWITZERLAND) 2023; 3:321-334. [PMID: 38084312 PMCID: PMC10712412 DOI: 10.3390/youth3010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Physical activity (PA), sleep, and weight are important factors for youth health. However, data about these factors are unknown in youth living in isolated Alaska Native communities. This study aims to assess PA, sleep, height and weight in elementary through high school students living in Anaktuvuk Pass. Fourteen children (<12) and 24 youths (12-20) volunteered to participate in this study. PA and sleep data were collected with actigraphy. Height and weight were assessed with standard procedures. Demographics were collected via survey. Results show that 10.53% and 18.42% of participants were overweight and obese, respectively. Average bedtime was 00:15 am and wake time 08:23 am. Total sleep time was 498.21 min. Participants averaged 477.64 min in sedentary activity, 297.29 min in light activity, 150.66 min in moderate activity, and 18.05 min in vigorous activity. Adjusted models suggest that high school students engage in significantly more sedentary activity, and significantly less light, moderate, and vigorous activity compared to those in middle and elementary school. All students engaged in less moderate and vigorous activity on the weekend compared to the weekday. Data suggest that as children age they become more sedentary. Future studies should focus on increasing daily PA in high school students while considering other obesogenic factors.
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Affiliation(s)
- Vernon Grant
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT 59717, USA
| | - Deborah Mekiana
- Alaska Native Studies, University of Alaska, Fairbanks, AK 99775, USA
| | - Jacques Philip
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK 99775, USA
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23
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John-Henderson NA, Grant VM, Johnson LR, Lafromboise ME, Malatare M, Salois EM, Oosterhoff B. Historical loss: Implications for physical activity levels in American Indian adults. J Rural Health 2023; 39:367-373. [PMID: 35508763 PMCID: PMC9633579 DOI: 10.1111/jrh.12673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the relationship between daily thoughts about historical loss and daily levels of moderate to vigorous physical activity (MVPA) in American Indian (AI) adults residing on the Blackfeet reservation in Browning, Montana. METHODS The study was designed and conducted using a community-based participatory research framework and ecological momentary assessment. Over a period of 1 week, 100 AI adults (mean age = 42.18, SD = 14.92) reported how often they thought about historical loss at the end of each day. During this week-long period, all participants wore a wrist-accelerometer to passively and objectively measure levels of physical activity. FINDINGS We found that Blackfeet AI adults who reported thinking about historical loss more frequently over the course of the week had lower average levels of MVPA over the course of the week compared to Blackfeet AI adults who reported thinking about historical loss less frequently (B = -10.22, 95% CI = -13.83, -6.60). We also found that on days when Blackfeet AI adults thought more about historical loss compared to their weekly average, they had fewer minutes of MVPA compared to their weekly average of minutes of MVPA (B = -0.87, 95% CI = -1.48, -0.27). CONCLUSIONS Our data indicate that thoughts about historical loss are linked to lower levels of MVPA. Given high incidence of chronic health conditions linked to physical inactivity in AIs, more work is needed to identify the mechanisms through which thoughts about historical loss may inhibit physical activity in this population.
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Affiliation(s)
- Neha A John-Henderson
- Department of Psychology, Montana State University, Bozeman, Montana, USA
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | - Vernon M Grant
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
| | | | | | | | - Emily M Salois
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, Montana, USA
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Mavragani A, Shane AL, Guinn TR, Apok CR, Collier AF, Avey JP, Donovan DM. The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study. JMIR Form Res 2023; 7:e38894. [PMID: 36473107 PMCID: PMC9944154 DOI: 10.2196/38894] [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: 04/20/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. OBJECTIVE This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. METHODS From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ≥21 years and 8 providers in a tribal health care organization in south-central Alaska. RESULTS Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. CONCLUSIONS This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users.
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Affiliation(s)
| | | | | | | | - Ann F Collier
- Southcentral Foundation, Anchorage, AK, United States
| | - Jaedon P Avey
- Southcentral Foundation, Anchorage, AK, United States
| | - Dennis M Donovan
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, United States
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Roh S, Lee YS. Developing Culturally Tailored Mobile Web App Education to Promote Breast Cancer Screening: Knowledge, Barriers, and Needs Among American Indian Women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-022-02252-x. [PMID: 36631714 PMCID: PMC10366295 DOI: 10.1007/s13187-022-02252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
American Indian (AI) women face disproportionate rates of breast cancer mortality and cancer disparities. This study conducted qualitative research to assess perspectives of AI women towards breast cancer screening, knowledge, barriers, and needs about mobile web app-based education to promote breast cancer screening. This study, in collaboration with the Yankton Sioux Tribe (YST), followed a community-based participatory research approach and conducted two focus groups with a total of 22 YST women aged 40-70 years living on reservation in rural South Dakota. Each group consisted of 11 local professionals working in healthcare and social services and community members. A grounded theory was used for the qualitative analysis. A large portion of participants reported having prior knowledge about breast cancer and screening methods, yet lacked awareness of the detailed procedure and recommended guidelines. Competing priorities and cost of mammograms were noted as major barriers to screening. Participants wanted to learn-in a convenient and easy-to-understand manner-more about breast cancer and prevention from a credible source. Both groups were favorable toward novel educational tools, such as the mobile web app education, and cited potential health benefits, particularly for women aged 40s to 60s. Our findings highlighted the importance of creating effective, culturally tailored educational interventions built into programs specific to AIs to increase understanding about breast cancer screening and promote screening behaviors among AI women. Particular attention to how AIs' culture, beliefs, and barriers are implicated in screening behaviors could help with developing culturally tailored health education tools for this population.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota-Sioux Falls, 4801 North Career Ave, 145C, Sioux Falls, SD, 57107, USA.
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, 1600 Holloway Avenue, HSS 216, San Francisco, CA, 94132, USA
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McCarthy MJ, Garcia YE, Remiker M, Hustead MLR, Bacon R, Williamson HJ, Dunn DJ, Baldwin JA. Diverse rural caregivers for individuals with Alzheimer's disease or related dementias: analysis of health factors at the individual, interpersonal, and community level. Aging Ment Health 2023; 27:94-100. [PMID: 35098811 PMCID: PMC9339023 DOI: 10.1080/13607863.2022.2026880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: Approximately 6.2 million Americans aged 65 or older have Alzheimer's disease or related dementias (ADRD). Unpaid family members and friends provide the bulk of caregiving for these individuals. Caregiving in rural areas adds unique challenges, particularly for ethnically/racially diverse caregivers. This study provides a profile of diverse, rural ADRD caregivers with an emphasis on multi-level factors that influence physical and mental health.Methods: A cross-sectional survey was conducted with 156 diverse rural ADRD caregivers.Results: 65% of participants identified as White/Non-Hispanic (WNH; n = 101) and 35% identified as ethnically/racially diverse (ERD; n = 55). The majority of participants reported economic deprivation. More ERD caregivers were uninsured and had at least one chronic health condition. Higher proportions of ERD caregivers smoked cigarettes, consumed alcohol regularly, and had not seen or talked to a doctor in the previous year. There were no ethnic/racial group differences in stress, anxiety, depressive symptoms, subjective health, or sleep quality.Conclusion: Rural caregivers, regardless of ethnicity/race, may benefit from extra supports in order to maintain optimal health. Further research is needed to disentangle the complex relationship between culture, caregiving, and health.
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Affiliation(s)
| | - Y. Evie Garcia
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ
| | - Mark Remiker
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Rachel Bacon
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
| | | | - Dorothy J. Dunn
- School of Nursing, Northern Arizona University, Flagstaff, AZ
| | - Julie A. Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ
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Subica AM, Aitaoto N, Li Q, Morey BN, Wu LT, Iwamoto DK, Guerrero EG, Moss HB. Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021. Public Health Rep 2023; 138:164-173. [PMID: 36113145 PMCID: PMC9482884 DOI: 10.1177/00333549221123579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. METHODS NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses. RESULTS During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). CONCLUSIONS Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.
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Affiliation(s)
- Andrew M. Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, Riverside, CA, USA
| | - Nia Aitaoto
- Pacific Islander Center of Primary Care Excellence, San Leandro, CA, USA
| | - Qiuxi Li
- Special Services for Groups, Los Angeles, CA, USA
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Li-Tzy Wu
- School of Medicine, Duke University, Durham, NC, USA
| | - Derek K. Iwamoto
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Howard B. Moss
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, Riverside, CA, USA
- Department of Psychiatry, School of Medicine, University of California, Riverside, Riverside, CA, USA
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Parker T, Kelley A, Cooeyate N, Tsosie N. Tribal Perspectives on Hypertension: Results From the Center for Native American Health Native-CHART Needs Assessment. J Prim Care Community Health 2022; 13:21501319221144269. [PMID: 36524696 PMCID: PMC9761798 DOI: 10.1177/21501319221144269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE AND OBJECTIVES American Indian/Alaska Native (AI/AN) hypertension contributes to cardiovascular disease, the leading cause of premature death in this population. The purpose of this article is to document strategies, concerns, and barriers related to hypertension and cardiovascular disease from Native-Controlling Hypertension and Risks through Technology (Native-CHART) symposiums facilitated by the Center for Native American Health (CNAH). The objectives of this evaluation were to combine Health Needs Assessment (HNA) data and explore barriers and strategies related to hypertension while assessing changes in participants' perspectives over time (2017-2021). APPROACH CNAH followed an iterative process each year for planning the HNA, facilitating the HNA, and refining and reflecting on HNA findings over time. This involved 3 interconnected steps: (1) developing a shared understanding for the HNA, "Why are we here?," (2) facilitating the HNA during annual symposiums "What do we do?," and (3) reflecting on "What did we learn?". EVALUATION METHODS Data were collected using a culturally centered HNA co-created by the CNAH team and tribal partners. Qualitative data analysis utilized a culturally centered thematic approach and NVivo software version 12.0. Quantitative data analysis included summarizing frequency counts and descriptive statistics using Microsoft Excel. RESULTS Over the 5-year period, 212 Native-CHART symposium participants completed HNAs. Data collected from HNAs show persistent barriers and concerns and illuminate potential strategies to address AI/AN hypertension. Future efforts must explore effective strategies that build on community strengths, culture and traditions, and existing resources. This is the path forward. IMPLICATIONS FOR PUBLIC HEALTH CNAH's culturally centered and unique HNA approach helped assess participant perspectives over time. CNAH facilitated symposiums over multiple years, even amid a global pandemic. This demonstrates resilience and continuity of community outreach when it is needed the most. Other universities and tribal partners could benefit from this iterative approach as they work to design HNAs with tribal populations.
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Affiliation(s)
- Tassy Parker
- Center for Native American Health-a
Public Health Institute for Indigenous Knowledge & Development, Albuquerque, NM,
USA,Tassy Parker, Ph.D., RN, Citizen of the
Seneca Nation, Director, Center for Native American Health, Professor with
Tenure, Department of Family and Community Medicine, Professor, Colleges of
Nursing and Population Health, Associate Vice President for American Indian
Health Research & Education, University of New Mexico Health Sciences, MSC07
4246, 1 UNM, 1001 Medical Arts Ave NE, Albuquerque, NM 87102, USA.
| | | | - Norman Cooeyate
- Center for Native American Health-a
Public Health Institute for Indigenous Knowledge & Development, Albuquerque, NM,
USA
| | - Nathania Tsosie
- Center for Native American Health-a
Public Health Institute for Indigenous Knowledge & Development, Albuquerque, NM,
USA
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Clarke GS, Douglas EB, House MJ, Hudgins KE, Campos S, Vaughn EE. Empowering Indigenous Communities Through a Participatory, Culturally Responsive Evaluation of a Federal Program for Older Americans. THE AMERICAN JOURNAL OF EVALUATION 2022; 43:484-503. [PMID: 36510484 PMCID: PMC9732784 DOI: 10.1177/10982140211030557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This article describes our experience of conducting a 5-year, culturally responsive evaluation of a federal program with Indigenous communities. It describes how we adapted tenets from "participatory evaluation models" to ensure cultural relevance and empowerment. We provide recommendations for evaluators engaged in similar efforts. The evaluation included stakeholder engagement through a Steering Committee and an Evaluation Working Group in designing and implementing the evaluation. That engagement facilitated attention to Indigenous cultural values in developing a program logic model and medicine wheel and in gathering local perspectives through storytelling to facilitate understanding of community traditions. Our ongoing assessment of program grantees' needs shaped our approach to evaluation capacity building and development of a diverse array of experiential learning opportunities and user-friendly tools and resources. We present practical strategies from lessons learned during the evaluation design and implementation phases of our project that might be useful for other evaluators.
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Affiliation(s)
| | | | | | - Kristen E.G. Hudgins
- Office of Performance and Evaluation, Center for Policy and
Evaluation, Administration for Community Living, U.S. Department of Health and Human
Services, Washington, DC, USA
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Kreski NT, Chen Q, Olfson M, Cerdá M, Martins SS, Mauro PM, Hasin DS, Keyes KM. National Trends and Disparities in Bullying and Suicidal Behavior Across Demographic Subgroups of US Adolescents. J Am Acad Child Adolesc Psychiatry 2022; 61:1435-1444. [PMID: 35489630 DOI: 10.1016/j.jaac.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/09/2022] [Accepted: 04/20/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Suicidal behavior and bullying victimization are important indicators of adolescent psychological distress, and are patterned by sex, race/ethnicity and sexual identity. This study aimed to estimate trends and disparities in these factors along with key demographics. METHOD Youth Risk Behavior Survey data (2015-2019, N = 44,066) were collected biennially through national cross-sectional surveys of US school-attending adolescents. Survey-weighted logistic regressions examined disparities in past-year bullying and suicidal behavior, overall and by demographics. RESULTS Bullying in 2019 was highest for female (vs male) students (odds ratio [OR] = 1.82, 95% CI = 1.62, 2.06), American Indian/Alaskan Native (vs White) students (OR = 1.48, 95% 0.91, 2.41, p > .05), and gay/lesbian (vs heterosexual) students (OR = 2.81, 95% CI = 2.07, 3.81). Suicidal behavior disparities affected similar groups. There was minimal evidence for shifts in disparities since 2015, with the exception of bullying for gay/lesbian adolescents. The prevalence of bullying victimization among gay and lesbian adolescents went from 31.6% to 44.5% between 2015 and 2019, surpassing the bisexual and "Not Sure" groups to be the sexual identity group with the highest rate of bullying victimization. CONCLUSION Interventions that operate on multiple structural levels and empower marginalized youth are needed.
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Affiliation(s)
- Noah T Kreski
- Columbia University, Mailman School of Public Health, New York, New York.
| | - Qixuan Chen
- Columbia University, Mailman School of Public Health, New York, New York
| | - Mark Olfson
- Columbia University, Mailman School of Public Health, New York, New York; New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Magdalena Cerdá
- New York University Grossman School of Medicine, New York, New York
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, New York, New York
| | - Pia M Mauro
- Columbia University, Mailman School of Public Health, New York, New York
| | - Deborah S Hasin
- Columbia University, Mailman School of Public Health, New York, New York; New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Katherine M Keyes
- Columbia University, Mailman School of Public Health, New York, New York
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Crocetti AC, Cubillo (Larrakia) B, Lock (Ngiyampaa) M, Walker (Yorta Yorta) T, Hill (Torres Strait Islander) K, Mitchell (Mununjali) F, Paradies (Wakaya) Y, Backholer K, Browne J. The commercial determinants of Indigenous health and well-being: a systematic scoping review. BMJ Glob Health 2022; 7:bmjgh-2022-010366. [PMID: 36319033 PMCID: PMC9628540 DOI: 10.1136/bmjgh-2022-010366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Health inequity within Indigenous populations is widespread and underpinned by colonialism, dispossession and oppression. Social and cultural determinants of Indigenous health and well-being are well described. Despite emerging literature on the commercial determinants of health, the health and well-being impacts of commercial activities for Indigenous populations is not well understood. We aimed to identify, map and synthesise the available evidence on the commercial determinants of Indigenous health and well-being. METHODS Five academic databases (MEDLINE Complete, Global Health APAPsycInfo, Environment Complete and Business Source Complete) and grey literature (Australian Indigenous HealthInfoNet, Google Scholar, Google) were systematically searched for articles describing commercial industry activities that may influence health and well-being for Indigenous peoples in high-income countries. Data were extracted by Indigenous and non-Indigenous researchers and narratively synthesised. RESULTS 56 articles from the USA, Canada, Australia, New Zealand, Norway and Sweden were included, 11 of which were editorials/commentaries. The activities of the extractive (mining), tobacco, food and beverage, pharmaceutical, alcohol and gambling industries were reported to impact Indigenous populations. Forty-six articles reported health-harming commercial practices, including exploitation of Indigenous land, marketing, lobbying and corporate social responsibility activities. Eight articles reported positive commercial industry activities that may reinforce cultural expression, cultural continuity and Indigenous self-determination. Few articles reported Indigenous involvement across the study design and implementation. CONCLUSION Commercial industry activities contribute to health and well-being outcomes of Indigenous populations. Actions to reduce the harmful impacts of commercial activities on Indigenous health and well-being and future empirical research on the commercial determinants of Indigenous health, should be Indigenous led or designed in collaboration with Indigenous peoples.
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Affiliation(s)
- Alessandro Connor Crocetti
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Beau Cubillo (Larrakia)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Mark Lock (Ngiyampaa)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Troy Walker (Yorta Yorta)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Karen Hill (Torres Strait Islander)
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | | | - Yin Paradies (Wakaya)
- Deakin University Alfred Deakin Institute for Citizenship and Globalisation, Burwood, Victoria, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Jennifer Browne
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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O'Connell J, Grau L, Goins T, Perraillon M, Winchester B, Corrada M, Manson SM, Jiang L. The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs. Alzheimers Dement 2022; 18:2055-2066. [PMID: 35176207 PMCID: PMC10440154 DOI: 10.1002/alz.12603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Little is known about treatment costs for American Indian and Alaska Native (AI/AN) adults with dementia who access services through the Indian Health Service (IHS) and Tribal health programs. METHODS We analyzed fiscal year 2013 IHS/Tribal treatment costs for AI/ANs aged 65+ years with dementia and a matched sample without dementia (n = 1842) to report actual and adjusted total treatment costs and costs by service type. Adjusted costs were estimated using multivariable regressions. RESULTS Mean total treatment cost for adults with dementia were $13,027, $5400 higher than for adults without dementia ($7627). The difference in adjusted total treatment costs was $2943 (95% confidence interval [CI]: $1505, $4381), the majority of which was due to the difference in hospital inpatient costs ($2902; 95% CI: $1512, $4293). DISCUSSION Knowing treatment costs for AI/ANs with dementia can guide enhancements to policies and services for treating dementia and effectively using health resources.
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Affiliation(s)
- Joan O'Connell
- University of Colorado, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Grau
- University of Colorado, Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Turner Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Marcelo Perraillon
- University of Colorado, Colorado School of Public Health, Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Blythe Winchester
- Eastern Band of Cherokee Indians, Cherokee Indian Hospital; Indian Health Service, Chief Clinical Consultant, Geriatrics and Palliative Care, Cherokee Indian Hospital, Cherokee, North Carolina, USA
| | - Maria Corrada
- University of California Irvine, College of Health Sciences, Department of Epidemiology and Biostatistics, Irvine, California, USA
| | - Spero M Manson
- University of Colorado, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luohua Jiang
- University of California Irvine, College of Health Sciences, Department of Epidemiology and Biostatistics, Irvine, California, USA
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Scott BG, Sunchild L, Small C, McCullen JR. Anxiety and Depression in Northern Plains American Indian Youth: Evidence for Resilience and Risk. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022:1-13. [PMID: 36206519 PMCID: PMC10079783 DOI: 10.1080/15374416.2022.2127101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Developing research collaborations with Indigenous communities to understand the expression and experience of anxiety and depression in American Indian (AI) youth and identifying protective and risk factors may be an important first step toward addressing AI health inequities. We used a community-based participatory research (CBPR) approach to investigate anxiety and depressive disorder symptoms among AI youth living on a Northern Plains reservation. Moreover, we examined whether symptoms were related to two potential protective and risk factors, anxiety control beliefs and rumination. Our tribal research team collected multi-reporter survey data from 71 AI 3rd-6th graders (8-13-years-old; 62.3% female) attending a tribal school, their caregivers, and teachers. Results pointed toward resilience in this sample with 7.3% and 8.7% of AI youth reporting clinical levels of anxiety and depressive disorder symptoms, respectively, and on average experiencing symptoms "Sometimes." There were moderate correlations between youth- and teacher-reported anxiety and depressive disorder symptoms, but no correlation with caregivers. Anxiety control beliefs were lower in older compared to younger AI youth and negatively related to youth-reported anxiety and depressive disorder symptoms, while rumination was positively related to youth-reported anxiety and depressive disorder symptoms and teacher-reported anxiety disorder symptoms. Age moderated relations between anxiety control beliefs and both youth-reported anxiety and depressive disorder symptoms with only significant relations found for older youth. Our findings are consistent with research showing resilience to internalizing problems in AI youth living on a reservation, but replication of their relations to anxiety control beliefs and rumination in other Indigenous peoples is warranted.
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Pete D, Erickson SL, Jim MA, Hatcher SM, Echo-Hawk A, Dominguez AE. COVID-19 Among Non-Hispanic American Indian and Alaska Native People Residing in Urban Areas Before and After Vaccine Rollout-Selected States and Counties, United States, January 2020-October 2021. Am J Public Health 2022; 112:1489-1497. [PMID: 36103693 PMCID: PMC9480478 DOI: 10.2105/ajph.2022.306966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate COVID-19 disparities among non-Hispanic American Indian/Alaska Native (AI/AN) and non-Hispanic White persons in urban areas. Methods. Using COVID-19 case surveillance data, we calculated cumulative incidence rates and risk ratios (RRs) among non-Hispanic AI/AN and non-Hispanic White persons living in select urban counties in the United States by age and sex during January 22, 2020, to October 19, 2021. We separated cases into prevaccine (January 22, 2020-April 4, 2021) and postvaccine (April 5, 2021-October 19, 2021) periods. Results. Overall in urban areas, the COVID-19 age-adjusted rate among non-Hispanic AI/AN persons (n = 47 431) was 1.66 (95% confidence interval [CI] = 1.36, 2.01) times that of non-Hispanic White persons (n = 2 301 911). The COVID-19 prevaccine age-adjusted rate was higher (8227 per 100 000; 95% CI = 6283, 10 770) than was the postvaccine rate (3703 per 100 000; 95% CI = 3235, 4240) among non-Hispanic AI/AN compared with among non-Hispanic White persons (2819 per 100 000; 95% CI = 2527, 3144; RR = 1.31; 95% CI = 1.17, 1.48). Conclusions. This study highlights disparities in COVID-19 between non-Hispanic AI/AN and non-Hispanic White persons in urban areas. These findings suggest that COVID-19 vaccination and other public health efforts among urban AI/AN communities can reduce COVID-19 disparities in urban AI/AN populations. (Am J Public Health. 2022;112(10):1489-1497. https://doi.org/10.2105/AJPH.2022.306966).
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Affiliation(s)
- Dornell Pete
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Scott L Erickson
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Melissa A Jim
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Sarah M Hatcher
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Abigail Echo-Hawk
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
| | - Adrian E Dominguez
- Dornell Pete, Scott L. Erickson, Abigail Echo-Hawk, and Adrian E. Dominguez are with the Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA. Melissa A. Jim is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Albuquerque, NM. Sarah M. Hatcher is with the Research Triangle Institute International, Durham, NC
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Wilkins K. Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2585-2612. [PMID: 36160377 PMCID: PMC9483472 DOI: 10.1007/s11113-022-09739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Influenza vaccination is a critical preventive healthcare behavior designed to prevent spread of seasonal flu. This paper contributes to existing scholarship by applying an intersectional perspective to examine how influenza vaccination differs across specific intersections of racial/ethnic and sexual identity. Drawing on aggregated state-level data from Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2020, I examine how flu vaccination differs across 18 racial/ethnic-by-sexual orientation groups (N = 1,986,432). Findings from descriptive analyses and logistic regression modeling demonstrate three key findings. First, it corroborates previous studies of vaccination, finding lower rates of flu vaccination among black adults relative to whites; gays/lesbians vaccinate at higher rates than heterosexuals and bisexuals, with bisexuals reporting lower vaccination relative to both heterosexuals and gays/lesbians. Second, it demonstrates how sexual orientation complicates established patterns between race/ethnicity and vaccination (e.g., influenza vaccination is more racially stratified among heterosexuals, with patterns more variable among gays/lesbians) and how race/ethnicity complicates previous patterns of vaccination by sexual orientation (e.g., Asian bisexuals vaccinate more than both heterosexuals). Third, findings pinpoint identities (e.g., black heterosexuals relative to their white peers and white bisexuals relative to their gay/lesbian peers) most in need of influenza vaccination outreach efforts. Implications for findings suggest that heterosexuals, especially black, may be less likely to vaccinate against influenza thus may need more encouragement from clinicians to vaccinate. Additionally, influenza vaccination should be free for all persons to lessen the barrier of access for this preventative healthcare.
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Affiliation(s)
- Kiana Wilkins
- Department of Sociology, Rice University, 6100 Main Street, Houston, TX MS-2877005 USA
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Yellow Horse AJ, Acciai F, Huyser KR. The Missing and Murdered Indigenous Relatives Crisis and the Life Expectancy Gap for Native Americans, 2010-2019. Epidemiology 2022; 33:739-746. [PMID: 35585668 DOI: 10.1097/ede.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed the role of missing and murdered indigenous relatives (MMIR) relevant causes of death in the life expectancy gap between the American Indian and Alaska Native (AIAN) and non-Hispanic White populations. METHODS Using 2010-2019 National Center for Health Statistics Detailed Mortality files, we created multidecrement life tables and used the age-incidence decomposition method to identify (1) the causes of death that contribute to the gap in life expectancy between White and AIAN, and (2) the mechanisms through which these causes operate. RESULTS Causes of death relevant to MMIR constituted 4.0% of all AIAN deaths, but accounted for almost one-tenth (9.6%; 0.74 of 8.21 years) of the overall AIAN-White life expectancy gap. MMIR-relevant causes accounted for 6.6% of the AIAN-White life expectancy gap for women and 11.9% of the for men. CONCLUSIONS This study suggests a critical agenda for research on racial inequities in mortality, with a focus on MMIR.
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Isaacson MJ, Duran T, Johnson G, Soltoff A, Jackson S, Petereit D, Armstrong K, Daubman BR. "Calling the Spirit Back:" Spiritual Needs Among Great Plains American Indians. J Pain Symptom Manage 2022; 64:268-275. [PMID: 35618248 PMCID: PMC9378634 DOI: 10.1016/j.jpainsymman.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT American Indians (AIs) are disproportionately affected by serious illness such as cancer. Colonization, cultural genocide, and trauma have adversely affected AIs' ability to attain health and well-being, and in many cases led to the loss of the right to practice traditional ceremonies and rituals. Still many AIs describe well-being as being rooted in spirituality. OBJECTIVES The purpose of this project was to learn about the perspectives of AI cancer survivors, caregivers, and Tribal leaders and healers specific to spirituality while on the cancer journey. METHODS Qualitative interviews and Indigenous talking circle methodologies were used to explore AIs cancer survivors, caregivers, and Tribal leaders and healers' perspectives on spirituality while on the cancer journey. A data analysis team consisting of AI and non-AI members analyzed the narrative data. RESULTS Qualitative analysis of interviews and talking circles revealed 4 major themes related to spirituality: the chasm of colonialism, coexistence of Traditional and Christian religions, calling the Spirit back, and prayer as sacred energy. CONCLUSION It is critical that clinicians caring for AIs with serious illness seek to understand their patients' spiritual beliefs about disease treatment and death and work with them and their families to support quality of life throughout their illness journey. In addition, clinicians must recognize the systemic racism inherent in our healthcare systems, and dismantle cultural clashes and bias for all patients, particularly AIs, who have long suffered from poorer health outcomes.
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Affiliation(s)
- Mary J Isaacson
- South Dakota State University, College of Nursing (M.J.I.), Rapid City, South Dakota, USA.
| | - Tinka Duran
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Gina Johnson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Alexander Soltoff
- Department of Medicine (A.S.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sean Jackson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Daniel Petereit
- Department of Radiation Oncology (D.P.), Monument Health Cancer Care Institute, Walking Forward, Avera Research Institute, Avera Health, Rapid City, South Dakota, USA
| | - Katrina Armstrong
- Dean, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine (B.-R. D.), Massachusetts General Hospital, Boston, Massachusetts, USA
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Soltoff A, Purvis S, Ravicz M, Isaacson MJ, Duran T, Johnson G, Sargent M, LaPlante JR, Petereit D, Armstrong K, Daubman BR. Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians. J Pain Symptom Manage 2022; 64:276-286. [PMID: 35618250 PMCID: PMC10230738 DOI: 10.1016/j.jpainsymman.2022.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land. OBJECTIVES This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs. METHODS Three authors recorded and transcribed interviews with 21 specialty and 17 primary clinicians. A data analysis team of seven authors analyzed transcripts using conventional content analysis. The analysis team met over Zoom to engage in code negotiation, classify codes, and develop themes. RESULTS Qualitative analysis of interview data revealed four themes encompassing factors influencing palliative care delivery and access for Great Plains American Indians: health care system operations (e.g., hospice and home health availability, fragmented services), geography (e.g., weather, travel distances), workforce elements (e.g., care continuity, inadequate staffing, cultural familiarity), and historical trauma and racism. CONCLUSION Our findings emphasize the importance of addressing the time and cost of travel for seriously ill patients, increasing home health and hospice availability on reservations, and improving trust in the medical system. Strengthening the AI medical workforce, increasing funding for the Indian Health Service, and transitioning the governance of reservation health care to Tribal entities may improve the trustworthiness of the medical system.
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Affiliation(s)
- Alexander Soltoff
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA.
| | - Sara Purvis
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA
| | - Miranda Ravicz
- Department of Medicine (A.S., S.P., M.R.), Massachusetts General Hospital, Boston, MA, USA
| | - Mary J Isaacson
- College of Nursing South Dakota State University (M.J.I.), Rapid City, SD, USA
| | - Tinka Duran
- Community Health Prevention Programs (T.D., G.J.), Great Plains Tribal Leaders Health Board, Rapid City, SD, USA
| | - Gina Johnson
- Community Health Prevention Programs (T.D., G.J.), Great Plains Tribal Leaders Health Board, Rapid City, SD, USA
| | - Michele Sargent
- Walking Forward (M.S., D.P.), Avera Research Institute, Avera Health, Rapid City, SD, USA
| | - J R LaPlante
- American Indian Health Initiative (J.R.L.), Avera Health, Sioux Falls, SD, USA
| | - Daniel Petereit
- Walking Forward (M.S., D.P.), Avera Research Institute, Avera Health, Rapid City, SD, USA
| | | | - Bethany-Rose Daubman
- Massachusetts General Hospital, Division of Palliative Care and Geriatric Medicine (B.R.D.), Boston, MA, USA
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Lumpkins CY, Goeckner R, Hale J, Lewis C, Gunville J, Gunville R, Daley CM, Daley SM. In Our Sacred Voice - An Exploration of Tribal and Community Leader Perceptions as Health Communicators of Disease Prevention among American Indians in the Plains. HEALTH COMMUNICATION 2022; 37:1180-1191. [PMID: 34949125 DOI: 10.1080/10410236.2021.2008108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
American Indians (AI) are disproportionately and significantly impacted by disease morbidity, mortalityand poor behavioral health outcomes. Health promotion and health communication programs exist to address these health disparities and health conditions; however, few programs fully integrate holistic approaches when targeting AI populations. The objective of this study was to explore how tribal and community leaders throughout the Central Plains (Kansas, Iowa, Missouri, and South Dakota) viewed themselves as health communicators and health promoters within their communities. Members of the Center for American Indian Community Health (CAICH) conducted 39 in-depth interviews with members of federally recognized tribes living in reservation communities as well as urban tribal communities across the region. Results from the sample show that these individuals do not necessarily see themselves as the "authority" health communicator or health promoter within their tribe or community. They did perceive themselves and others as gatekeepers of pertinent health information. Social and cultural authority within culturally centered messaging and collective delivery of this type of health information from trusted sources within tribes and communities is perceived to bolster health communication programs and positively impact health outcomes among AI populations.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Family Medicine and Community Health, University of Kansas Medical Center
- William Allen White School of Journalism and Mass Communications, University of Kansas-Lawrence
| | | | - Jason Hale
- Lehigh College of Health, Institute for Indigenous Studies
| | - Charley Lewis
- Lehigh College of Health, Institute for Indigenous Studies
| | | | - River Gunville
- Lehigh College of Health, Institute for Indigenous Studies
| | - Chris M Daley
- Lehigh College of Health, Institute for Indigenous Studies
| | - Sean M Daley
- Lehigh College of Health, Institute for Indigenous Studies
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O'Connell J, Grau L, Manson SM, Bott AM, Sheffer K, Steers R, Jiang L. Use of clinical pharmacy services by American Indians and Alaska Native adults with cardiovascular disease. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:800-811. [PMID: 36246030 PMCID: PMC9544095 DOI: 10.1002/jac5.1651] [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: 02/14/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022]
Abstract
Introduction The Indian Health Service (IHS) and Tribal health programs provide clinical pharmacy services to improve health outcomes among American Indian and Alaska Native (AI/AN) adults with cardiovascular disease (CVD). Objectives The study's primary objective was to describe characteristics, including social determinants of health (SDOH), associated with clinical pharmacy utilization by AI/ANs with CVD who accessed IHS/Tribal services. A secondary objective assessed changes in systolic blood pressure (SBP) associated with such utilization. Methods Analysis included IHS data for 9844 adults aged 18 and older with CVD who lived in 5 locations. Multivariable logistic regression was used to examine patient characteristics (eg, age, sex, health status, SDOH) associated with clinical pharmacy utilization in fiscal year (FY) 2012. A propensity score model was employed to estimate the association of elevated SBP in FY2013 with FY2012 clinical pharmacy utilization. Results Nearly 15% of adults with CVD used clinical pharmacy services. Among adults with CVD, the odds of clinical pharmacy use were higher among adults diagnosed with congestive heart failure (adjusted odds ratio [OR] = 1.22; 95% CI:1.01-1.47), other types of heart disease not including ischemia (OR = 1.40; 95% CI: 1.18-1.65), and vascular disease (OR = 1.23; 95% CI: 1.04-1.46), compared to adults without these conditions. Diabetes (OR = 4.05, 95% CI: 3.29-5.00) and anticoagulation medication use (OR = 20.88, 95% CI: 16.76-20.61) were associated with substantially higher odds of clinical pharmacy utilization. Medicaid coverage (OR = 0.72; 95% CI: 0.56-0.93) and longer travel times to services (OR = 0.87; 95% CI: 0.83-0.92) were each associated with lower odds. FY2012 clinical pharmacy users had lower odds of elevated SBP (OR = 0.71 95% CI: 0.58-0.87) in FY2013 than nonusers. Conclusion In addition to health status, SDOH (eg, Medicaid coverage, longer travel times) influenced clinical pharmacy utilization. Understanding characteristics associated with clinical pharmacy utilization may assist IHS/Tribal health programs in efforts to support optimization of these services.
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Affiliation(s)
- Joan O'Connell
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Laura Grau
- Present address:
Department of Biostatistics, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | - Spero M. Manson
- Present address:
Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of ColoradoAuroraColoradoUSA
| | | | - Kyle Sheffer
- Santa Fe Indian Health CenterSanta FeNew MexicoUSA
| | | | - Luohua Jiang
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaIrvineCaliforniaUSA
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Pedersen M, Harris KJ, Brown B, Anderson K, Lewis JP. A Systematic Review of Interventions to Increase Physical Activity Among American Indian and Alaska Native Older Adults. THE GERONTOLOGIST 2022; 62:e328-e339. [PMID: 33605417 PMCID: PMC9335984 DOI: 10.1093/geront/gnab020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity (PA) is a powerful protective factor known to reduce risk for chronic conditions across the life span. PA levels are lower among American Indians and Alaska Natives (AIANs) when compared with other racial/ethnic groups and decrease with age. This evidence justifies a synthesis of current intervention research to increase PA levels among AIANs. This systematic review examines completed interventions to increase PA among AIAN older adults and considers recommended practices for research with Indigenous communities. RESEARCH DESIGN AND METHODS The systematic review was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic review protocols and reporting guidelines. Three electronic databases, PubMed, Web of Science, and PsycINFO, were searched for academic literature. Trials investigating interventions to increase PA among AIAN adults older than 50 years were eligible. The Quality Assessment Tool for Quantitative Studies was used to evaluate the quality of evidence. RESULTS Three published trials were identified, including one group-level, clinic-based and two individual-level, home-based interventions. All were 6 weeks in duration, took place in urban areas, and used self-report PA measures. Findings indicated an overall increase in PA levels, improved PA-related outcomes, and improved psychosocial health among participants. None described community-engaged or culture-centered research strategies. DISCUSSION AND IMPLICATIONS The narrow yet promising evidence represents a need for expanded research and a call to action for using culture-centered strategies. An advanced understanding of cultural and contextual aspects of PA may produce more impactful interventions, supporting health and mobility across the life span.
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Affiliation(s)
- Maja Pedersen
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Blakely Brown
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Keith Anderson
- School of Social Work, University of Texas at Arlington,
Arlington, Texas, USA
| | - Jordan P Lewis
- Department of Medicine and Biobehavioral Health, University of
Minnesota, Minnesota, Duluth, USA
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Janitz AE, Martinez SA, Campbell JE, Williams ML, Buckskin S, Armstrong C, Wickliffe T, Anderson AS, Doescher MP, Khan S. Linking the Cherokee Nation Cancer Registry With Electronic Medical Records: A Tribal-Academic Center Partnership. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:425-429. [PMID: 35121712 PMCID: PMC9142483 DOI: 10.1097/phh.0000000000001498] [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: 02/03/2023]
Abstract
The Cherokee Nation Cancer Registry (CNCR) is the only tribally operated Surveillance, Epidemiology, and End Results program registry. As registries, including the CNCR, lack detailed data characterizing health behavior or comorbidity, we aimed to enrich the CNCR by linking it with Cherokee Nation's electronic medical record (EMR). We describe the process of a tribal-academic partnership and linking records between the CNCR and the EMR for American Indian people diagnosed with cancer from 2015 to 2020. Prior to data linkage, our team worked with the Cherokee Nation Governance Board and Institutional Review Board to ensure tribal data sovereignty was maintained. While not all persons in the CNCR receive health care at Cherokee Nation, 63% linked with an EMR. We observed differences (P < .001) between cancer site, year at diagnosis, age at diagnosis, and gender by EMR linkage status. Once we further validate linkages and assess data completeness, we will evaluate relationships between behavioral risk factors, comorbidities, and cancer outcomes.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health (Drs Janitz, Martinez, and Campbell and Mss Williams and Anderson), and Department of Family Medicine, College of Medicine (Dr Doescher), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and Cherokee Nation Public Health, Cherokee Nation, Tahlequah, Oklahoma (Ms Buckskin and Messrs Armstrong, and Wickliffe and Dr Khan)
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Singal AK, Kuo YF, Arab JP, Bataller R. Racial and Health Disparities among Cirrhosis-related Hospitalizations in the USA. J Clin Transl Hepatol 2022; 10:398-404. [PMID: 35836764 PMCID: PMC9240250 DOI: 10.14218/jcth.2021.00227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/15/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Alcohol-associated liver disease (ALD) is the most common cause of advanced liver disease worldwide, including in the USA. Alcohol use and cirrhosis mortality is higher in American Indian/Alaska Native (AI/AN) compared to Whites. Data are scanty on ALD as a liver disease etiology in AI/AN compared to other races and ethnicities. METHODS The National Inpatient Sample on 199,748 cirrhosis-related hospitalizations, 14,241 (2,893 AI/AN, 2,893 Whites, 2,882 Blacks, 2,879 Hispanics, and 2,694 Asians or other races) matched 1:1 for race/ethnicity on demographics, insurance, and income quartile of the residence zip code analyzed. RESULTS After controlling for geographic location and hospital type, odds ratio (OR) and 95% confidence interval (CI) for ALD as cirrhosis etiology was higher among admissions in AI/AN vs. Whites [1.55 (1.37-1.75)], vs. Blacks [1.87 (1.65-2.11)], vs. Hispanic [1.89 (1.68-2.13)] and Asians/other races [2.24 (1.98-2.53)]. OR was also higher for AI/AN vs. all other races for alcohol-associated hepatitis (AH) as one of the discharge diagnoses. The findings were similar in a subgroup of 4,649 admissions with decompensated cirrhosis and in a cohort of 350 admissions with acute-on-chronic liver failure as defined by EASL-CLIF criteria. Alcohol use disorder diagnosis was present in 38% of admissions in AI/AN vs. 24-30% in other races, p<0.001. A total of 838 (5.9%) admissions were associated with in-hospital mortality. OR (95% CI) for in-hospital mortality in AI/AN individuals was 34% reduced vs. Blacks [0.66 (0.51-0.84)], but no difference was observed on comparison with other races. CONCLUSIONS ALD, including AH, is the most common etiology among cirrhosis-related hospitalizations in the USA among AI/AN individuals. In-hospital mortality was observed in about 6% of admissions, which was higher for Blacks and similar in other races compared to admissions for AI/AN. Public health policies should be implemented to reduce the burden of advanced ALD among AI/AN individuals.
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Affiliation(s)
- Ashwani K. Singal
- Department of Medicine, University of SD Sanford School of Medicine, Sioux Falls, SD, USA
- Division of Transplant Hepatology, Avera Transplant Institute, Sioux Falls, SD, USA
- Correspondence to: Ashwani K. Singal, University of South Dakota, Sanford School of Medicine, Avera McKennan University Hospital Transplant Institute, Sioux Falls, SD 57105, USA. ORCID: https://orcid.org/0000-0003-1207-3998. Tel: +1-605-322-8545, Fax: +1-605-322-8536, E-mail:
| | - Yong-Fang Kuo
- Department of Biostatistics, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Juan P. Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ramon Bataller
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Jaramillo ET, Haozous EA, Willging CE. Experiences of Health Insurance among American Indian Elders and Their Health Care Providers. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:351-374. [PMID: 34847224 PMCID: PMC9133029 DOI: 10.1215/03616878-9626880] [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: 06/13/2023]
Abstract
CONTEXT American Indian elders have a lower life expectancy than other aging populations in the United States because of inequities in health and in access to health care. To reduce such disparities, the 2010 Affordable Care Act included provisions to increase insurance enrollment among American Indians. Although the Indian Health Service remains underfunded, increases in insured rates have had significant impacts among American Indians and their health care providers. METHODS From June 2016 to March 2017, we conducted qualitative interviews with 96 American Indian elders (age 55+) and 47 professionals (including health care providers, outreach workers, public-sector administrators, and tribal leaders) in two southwestern states. Interviews focused on elders' experiences with health care and health insurance. We analyzed transcripts iteratively using open and focused coding techniques. FINDINGS Although tribal health programs have benefitted from insurance payments, the complexities of selecting, qualifying for, and maintaining health insurance are often profoundly alienating and destabilizing for American Indian elders and communities. CONCLUSIONS Findings underscore the inadequacy of health-system reforms based on the expansion of private and individual insurance plans in ameliorating health disparities among American Indian elders. Policy makers must not neglect their responsibility to directly fund health care for American Indians.
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Jaramillo ET, Sommerfeld DH, Haozous EA, Brunner A, Willging CE. Causes and Consequences of Not Having a Personal Healthcare Provider Among American Indian Elders: A Mixed-Method Study. Front Public Health 2022; 10:832626. [PMID: 35309185 PMCID: PMC8926165 DOI: 10.3389/fpubh.2022.832626] [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: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
Having a regular relationship with a healthcare provider contributes to better health outcomes and greater satisfaction with care for older adults. Although members of federally recognized American Indian tribes have a legal right to healthcare, American Indian Elders experience inequities in healthcare access that may compromise their ability to establish a relationship with a healthcare provider. This multi-year, community-driven, mixed-method study examines the potential causes and consequences of not having a personal healthcare provider among American Indian Elders. Quantitative surveys and qualitative interviews were conducted with 96 American Indian Elders (age 55 and over) in two states in the Southwestern United States. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. Findings confirmed that having a consistent healthcare provider correlated significantly with self-rated measures of health, confidence in getting needed care, access to overall healthcare, and satisfaction with care. Lack of a regular healthcare provider was related to interconnected experiences of self-reliance, bureaucratic and contextual barriers to care, and sentiments of fear and mistrust based in previous interactions with medical care. Increasing health equity for American Indian Elders will thus require tailored outreach and system change efforts to increase continuity of care and provider longevity within health systems and build Elders' trust and confidence in healthcare providers.
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Affiliation(s)
- Elise Trott Jaramillo
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - David H Sommerfeld
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Emily A Haozous
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - Amy Brunner
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Cathleen E Willging
- Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
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Nadeau M, Wise K, Farfan Cuela V, Olson D, Saravana K. Identification of Cancer Related Risk and Protective Factors for American Indian Youth: A Mixed Studies Review. Front Public Health 2022; 10:828776. [PMID: 35548066 PMCID: PMC9081341 DOI: 10.3389/fpubh.2022.828776] [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: 12/03/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Many causes of cancer related morbidity and mortality can be traced back to childhood behaviors. The culmination of cancer related risk and protective factors impacting the health and wellbeing of American Indian youth is unknown. The aim of this Mixed Studies Review was to identify cancer related risk and protective factors among American Indian youth. Results will be shared with Tribal communities to inform surveillance efforts. Methods A Mixed Studies Review process was deemed most appropriate for the search process and data collection. Seven databases were included in the search along with 3 databases that were hand searched. Google Scholar and Google power searching were also conducted. Covidence was utilized for abstract and full-text review. Out of 1,512 articles, 75 articles were included for review and data from each article was sorted out into the levels of the social ecological model. Results After extracting significant cancer related risk and protective factors from the 75 relevant articles, cancer related themes were identified at the individual, relationship (family and non-family), community, institutional, and cultural levels of the social ecological model. It was observed that the risk and protective factor profile for substance use spanned all levels of the social ecological model, whereas physical health-diet indicators and sexual health indicators did not. Most articles (n = 58, 77%) focused on substance use-related risk and protective factors. Discussion The method that was used for this study can be utilized by other professionals researching risk and protective factors impacting the health and wellbeing of American Indian youth for a multitude of health outcomes. Tribal communities will be able to use the results from our literature review to inform the creation of a community specific data collection tool focused on cancer related risk and protective factors. Upon completion of the overarching research, results will be shared with the community and can be used to inform ongoing surveillance efforts, influence priorities for intervention and education work, and inform the management of resources. The continuation of community informed and driven research with Tribal communities is essential to the health and wellbeing of Tribal Nations as community grounded research is limited.
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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: 36] [Impact Index Per Article: 18.0] [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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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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Li M, Hilpert M, Goldsmith J, Brooks JL, Shearston JA, Chillrud SN, Ali T, Umans JG, Best LG, Yracheta J, van Donkelaar A, Martin RV, Navas-Acien A, Kioumourtzoglou MA. Air Pollution in American Indian Versus Non-American Indian Communities, 2000-2018. Am J Public Health 2022; 112:615-623. [PMID: 35319962 PMCID: PMC8961849 DOI: 10.2105/ajph.2021.306650] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare fine particulate matter (PM2.5) concentrations in American Indian (AI)-populated with those in non-AI-populated counties over time (2000-2018) in the contiguous United States. Methods. We used a multicriteria approach to classify counties as AI- or non--AI-populated. We ran linear mixed effects models to estimate the difference in countywide annual PM2.5 concentrations from well-validated prediction models and monitoring sites (modeled and measured PM2.5, respectively) in AI- versus non-AI-populated counties. Results. On average, adjusted modeled PM2.5 concentrations in AI-populated counties were 0.38 micrograms per cubic meter (95% confidence interval [CI] = 0.23, 0.54) lower than in non-AI-populated counties. However, this difference was not constant over time: in 2000, modeled concentrations in AI-populated counties were 1.46 micrograms per cubic meter (95% CI = 1.25, 1.68) lower, and by 2018, they were 0.66 micrograms per cubic meter (95% CI = 0.45, 0.87) higher. Over the study period, adjusted modeled PM2.5 mean concentrations decreased by 2.13 micrograms per cubic meter in AI-populated counties versus 4.26 micrograms per cubic meter in non-AI-populated counties. Results were similar for measured PM2.5. Conclusions. This study highlights disparities in PM2.5 trends between AI- and non-AI-populated counties over time, underscoring the need to strengthen air pollution regulations and prevention implementation in tribal territories and areas where AI populations live. (Am J Public Health. 2022;112(4): 615-623. https://doi.org/10.2105/AJPH.2021.306650).
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Affiliation(s)
- Maggie Li
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Markus Hilpert
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Jeff Goldsmith
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Jada L Brooks
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Jenni A Shearston
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Steven N Chillrud
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Tauqeer Ali
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Jason G Umans
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Lyle G Best
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Joseph Yracheta
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Aaron van Donkelaar
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Randall V Martin
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Ana Navas-Acien
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
| | - Marianthi-Anna Kioumourtzoglou
- Maggie Li, Markus Hilpert, Jenni A. Shearston, Ana Navas-Acien, and Marianthi-Anna Kioumourtzoglou are with the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY. Jeff Goldsmith is with the Department of Biostatistics, Columbia University Mailman School of Public Health. Jada L. Brooks is with the University of North Carolina School of Nursing, Chapel Hill. Steven N. Chillrud is with the Lamont-Doherty Earth Observatory, Columbia University. Tauqeer Ali is with the Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City. Jason G. Umans is with the Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC. Lyle G. Best and Joseph Yracheta are with Missouri Breaks Industries Research, Inc., Eagle Butte, SD. Aaron van Donkelaar and Randall V. Martin are with the Department of Energy, Environmental & Chemical Engineering, Washington University, St. Louis, MO
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Clarke GS, Douglas EB, Campos S, House MJ, Vaughn EE, Hudgins KEG. Building connection and improving health for Indigenous elders: Findings from the Title VI evaluation. J Am Geriatr Soc 2022; 70:1525-1537. [PMID: 35338650 DOI: 10.1111/jgs.17761] [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: 10/07/2021] [Revised: 03/01/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND As the older Indigenous population in the United States expands, there is a growing demand for programs to address age-related needs. Although Title VI of the OAA provides culturally responsive strategies to support elders through home- and community-based nutrition services, these programs have not been the subject of a national evaluation; our study is the first. METHODS We conducted a mixed-methods study to assess the impact of the Title VI programs on elders. We used quantitative data from a national survey of Indigenous elders (n = 1175) and qualitative data collected through interviews (n = 36) and focus groups (18, n = 161) with a subgroup of elders receiving services. We compared outcomes for social and cultural connectedness and physical and mental well-being for different subgroups within our sample of elders based on elders' use of Title VI services and the level of services provided to these elders. Results were adjusted for community characteristics. RESULTS Elders receiving Title VI services had significantly fewer hospitalizations and falls per year (hospitalizations: 0.9 vs. 1.2, p < 0.05; falls: 1.0 versus 1.1, p < 0.05) and significantly more social and cultural engagements per month (social engagements: 92.6% vs. 75.6%, p < 0.05; cultural practices: 78.8% vs. 64.8%, p < 0.05) compared with elders who did not participate in Title VI services. These findings were confirmed by our qualitative data. CONCLUSIONS Our findings highlight the vital role that the Title VI program plays in promoting elders' overall health and well-being through decreased hospitalizations and falls and increased connectedness.
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Affiliation(s)
| | | | - Sofia Campos
- Health, Science, and Human Services, ICF, Atlanta, Georgia, USA
| | - Marnie J House
- Health, Science, and Human Services, ICF, Carmel, Indiana, USA
| | | | - Kristen E G Hudgins
- Office of Performance and Evaluation Center for Policy and Evaluation, Administration for Community Living, U.S. Department of Health and Human Services, Washington, District of Columbia, USA
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