American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use

OBJECTIVE

To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12-19 years in association with social determinants of health (SDOH), and mental health and substance use disorders.

METHODS

Guided by the World Health Organization's Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12-19 years. We described obesity prevalence in relationship to SDOH and adolescents' mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics.

RESULTS

We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001).

CONCLUSIONS

Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.

All systems are interrelated: Multilevel interventions with indigenous communities

Colonial historical trauma and ongoing structural racism have impacted Indigenous peoples for generations and explain the ongoing health disparities. However, Indigenous peoples have been engaging in multilevel, clinical trial interventions with Indigenous and allied research scientists resulting in promising success. In this paper, National Institutes of Health funded scientists in the field of Indigenous health have sought to describe the utility and need for multilevel interventions across Indigenous communities (Jernigan et al., 2020). We posit limitations to the existing socioecological, multilevel frameworks and propose a dynamic, interrelated heuristic framework, which focuses on the inter-relationships of the collective within the environment and de-centers the individual. We conclude with identified calls for action within multilevel clinical trial research.

Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children

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.

Identifying Perspectives About Health to Orient Obesity Intervention Among Urban, Transitionally Housed Indigenous Children

Drawing from a socioecological framework of health, this community-based participatory research study examined key cultural health perspectives of transitionally housed, food insecure Indigenous children (aged 8-12 years) by utilizing talking circles and a 4-day photovoice (PV) curriculum. In total, 18 Indigenous children portrayed their health perceptions by taking photographs of their living environment and categorizing photos as healthy, unhealthy, or mixed. And, 10 of the 18 children completed pre- and post-evaluations, where data elucidated that urban Indigenous children experiencing food and housing insecurity demonstrate unique holistic and socioecological perceptions about health. Healthy themes included nutrition, gardening, interpersonal relationships, food sovereignty, water quality, and natural and built environments. Unhealthy themes included cumulative stress, food insecurity, access and cost, screen time, smoking, and violence. We found that implementing these robust insights into urban Indigenous obesity prevention interventions could significantly drive success. This approach may benefit children with similar socioecological strengths and vulnerabilities.

The Prevalence and Correlates of Mental and Emotional Health Among American Indian Adults With Type 2 Diabetes

AIMS

The purpose of this study was to examine the prevalence and correlates of mental and emotional health factors among a sample of American Indian (Indigenous) adults diagnosed with type 2 diabetes.

METHODS

Data are from a community-based participatory research project involving 2 Indigenous reservation communities. Data were collected from 218 Indigenous adults diagnosed with type 2 diabetes via in-person paper-and-pencil survey interviews.

RESULTS

Reports of greater numbers of mental/emotional health problems were associated with increases in self-reported hyperglycemia, comorbid health problems, and health-impaired physical activities.

CONCLUSIONS

This study addresses a gap in the literature by demonstrating the associations between various mental/emotional health factors and diabetes-related health problems for Indigenous Americans. Findings underscore the importance of holistic, integrated primary care models for more effective diabetes care.

What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline

BACKGROUND/AIMS

To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans.

METHODS

We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health.

RESULTS

Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time.

CONCLUSIONS

Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.