1
|
Cueva K, Peterson M, Chaliak AJ, Young RI. A qualitative exploration of the impacts of COVID-19 in two rural Southwestern Alaska communities. Int J Circumpolar Health 2024; 83:2313823. [PMID: 38563298 PMCID: PMC10989197 DOI: 10.1080/22423982.2024.2313823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
This manuscript presents a qualitative exploration of the experiences of people in two Southwestern Alaska communities during the emergence of COVID-19 and subsequent pandemic response. The project used principles of community based participatory research and honoured Indigenous ways of knowing throughout the study design, data collection, analysis, and dissemination. Data was collected in 2022 through group and individual conversations with community members, exploring impacts of the COVID-19 pandemic. Participants included Elders, community health workers, Tribal council members, government employees, school personnel, and emergency response personnel. Notes and written responses were coded using thematic qualitative analysis. The most frequently identified themes were 1) feeling disconnected from family, friends, and other relationships, 2) death, 3) the Tribal councils did a good job, and 4) loss of celebrations and ceremonies. While the findings highlighted grief and a loss of social cohesion due to the pandemic, they also included indicators of resilience and thriving, such as appropriate and responsive local governance, revitalisation of traditional medicines, and coming together as a community to survive. This case study was conducted as part of an international collaboration to identify community-driven, evidence-based recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies.
Collapse
Affiliation(s)
- Katie Cueva
- Institute of Social and Economic Research (ISER), University of Alaska, Anchorage, AK, USA
| | - Malory Peterson
- Department of Human Development and Community Health, Montana State University, Bozeman, USA
| | - Ay’aqulluk Jim Chaliak
- Center for Alaska Native Health Research (CANHR), University of Alaska Fairbanks, Bethel, AK, USA
| | | |
Collapse
|
2
|
Crouch MC. My mother and her masks: Alcohol, trauma, and strength. J Subst Use Addict Treat 2024; 157:209239. [PMID: 38061635 PMCID: PMC10922195 DOI: 10.1016/j.josat.2023.209239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Maria C Crouch
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States.
| |
Collapse
|
3
|
Fay Cyr L, Sagoonick MM. Knowledge Shared by Alaska Native Commercial Salmon Set Gillnetters in Norton Sound to Reduce Marine Fatalities. J Agromedicine 2024; 29:10-17. [PMID: 37598199 DOI: 10.1080/1059924x.2023.2249453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
OBJECTIVES The goal of this exploratory pilot study was to reduce marine fatalities in Norton Sound using knowledge shared from Alaska Native salmon set gillnetters in Unalakleet, AK. The following objectives to address this goal were: 1) identify factors that influence safety for Alaska Native commercial set gillnetters in Norton Sound; 2) use findings from objective 1 to improve commercial fishing training, education, and resources; and 3) disseminate and communicate results from objective 1 to commercial fishers in the Norton Sound fleet, commercial fishing safety partners, and the Alaska Native injury prevention community. METHODS Ten semi-structured interviews were conducted with Alaska Native commercial set gillnetters in Unalakleet, AK. We utilized knowledge shared to identify factors that influence safety for their fleet. Using an Interpretative Phenomenological Analysis Methodology, 10 interviews were recommended for a homogenous sample. RESULTS Most participants learned to fish at a young age from the family, with safety lessons passed on by family members. Fishing is a lifestyle and interconnected with harvesting and a way of living. Set gillnetters in Norton Sound use open skiffs and have limited access to workable Personal Flotation Devices (PFDs) and safety training. Participants reported health benefits but also negative long term physical effects, financial stress, and difficulty fishing with age. Respect and awareness of the ocean was reported as the most important strategy to reduce risk. Stories were shared of falls overboard, capsizing, and local fatalities and hazards, such as being overloaded with fish, entanglement, and maneuvering a small boat in large waves. Stronger winds and shifting weather patterns were experienced from climate change. CONCLUSION This exploratory pilot study identified factors that influence safety for Alaska Native commercial set gillnetters. Findings should be used to 1) determine best methods to influence behaviors to reduce risks in this hazardous fishery; 2) increase awareness and promote expanded application of best practices, equipment, and resources; 3) encourage and promote outreach initiatives targeted for this unique population; and 4) develop tailored training programs for commercial fishing in an open skiff. Research with Alaska Native fishing communities will require value and respect of indigenous knowledge, collaboration with local people, and follow-up to bring findings back to the community.
Collapse
Affiliation(s)
- Leann Fay Cyr
- Commercial Fishing Safety, Alaska Marine Safety Education Association, Sitka, AK, USA
| | | |
Collapse
|
4
|
Grage L, Cuellar MJ. Did text-based news-media coverage about the COVID-19 pandemic increase vaccine uptake? A population-based study in Alaska. Int J Circumpolar Health 2023; 82:2213913. [PMID: 37216574 DOI: 10.1080/22423982.2023.2213913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
COVID-19 vaccinations protect against severe infection, hospitalisation, and death. News media can be an important source of information for the public during a health crisis. This study explores the extent to which local or statewide text-based news coverage of the pandemic was related to the uptake of initial doses of COVID-19 vaccines among adults in Alaska. Multilevel modelling was employed to explore the association between news media intensity and vaccine uptake rates across boroughs and census areas, while controlling for relevant covariates. Results suggest that the intensity of news media did not significantly influence vaccine uptake during the majority of this time period and had a negative affect during the Delta-surge in the fall of 2021. However, the political lean and median age of boroughs or census areas were significantly associated with vaccine uptake. Race, poverty, or education were not significant determinants of vaccine uptake suggesting there are unique differences in Alaska compared to the U.S., particularly amongst Alaska Native people. The political environment in Alaska surrounding the pandemic was polarized. Future research in communications and channels that can cut through this polarized and politicized environment, and reach younger adults is needed.
Collapse
Affiliation(s)
- Laura Grage
- College of Health, Division of Population Health Sciences, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Matthew J Cuellar
- College of Health, School of Social Work, University of Alaska Anchorage, Anchorage, Alaska, USA
| |
Collapse
|
5
|
Haverkamp D, Redwood D, Roik E, Vindigni S, Thomas T. Elevated colorectal cancer incidence among American Indian/ Alaska native persons in Alaska compared to other populations worldwide. Int J Circumpolar Health 2023; 82:2184749. [PMID: 36867106 PMCID: PMC9987760 DOI: 10.1080/22423982.2023.2184749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Colorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease.
Collapse
Affiliation(s)
- Donald Haverkamp
- Epidemiologist, Centers for Disease Control and Prevention Albuquerque, NM, USA
| | - Diana Redwood
- Program Manager, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Elena Roik
- Program Director, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Stephen Vindigni
- Gastroenterologist, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.,Department of Gastroenterology, University of Washington, Seattle, WA, USA
| | - Timothy Thomas
- Research Services Director, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| |
Collapse
|
6
|
Eichelberger L, Hansen A, Cochran P, Hahn M, Fried R. COVID-19 vaccine decision-making in remote Alaska between November 2020 and November 2021. Int J Circumpolar Health 2023; 82:2242582. [PMID: 37535846 PMCID: PMC10402834 DOI: 10.1080/22423982.2023.2242582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
Vaccine hesitancy is an ongoing barrier to achieve sufficient COVID-19 vaccination coverage. Although there are many studies globally of vaccine hesitancy based on large survey samples, there are fewer in-depth qualitative studies that explore vaccine hesitancy and acceptance as a spectrum of decision-making. In this paper, we begin to describe vaccination decision-making among 58 adults living in remote Alaska based on three waves of online surveys and follow-up semi-structured interviews conducted between November 2020 and November 2021. The survey question of intention was not a predictor of adoption for about one third of the interviewees who were unvaccinated when they took the survey (n=12, 35%). Over half of all interviewees (n=37, 64%) had vaccine-related concerns, including 25 vaccinated individuals (representing 57% of vaccinated interviewees). Most interviewees reported that they learned about COVID-19 vaccines through interpersonal interactions (n=30, 52%) and/or a variety of media sources (n=29, 50%). The major facilitators of acceptance were trust in the information source (n=20, 48% of the 42 who responded), and learning from the experiences of family, friends, and the broader community (n=12, 29%). Further, trust and having a sense of agency appears to be important to interviewee decision-making, regardless of vaccination status and intention.
Collapse
Affiliation(s)
- Laura Eichelberger
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Amanda Hansen
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Micah Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
| | - Ruby Fried
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
| |
Collapse
|
7
|
Pennington ML, Ylitalo KR, Thomas KL, Coe E, Humphries M, Gulliver SB. Suicides among American Indian/ Alaska Native firefighters: Data from the National Violent Death Reporting System, 2003 - 2017. Psychiatry Res 2023; 330:115593. [PMID: 37951031 DOI: 10.1016/j.psychres.2023.115593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/13/2023]
Abstract
Suicide is a significant public health problem in the United States and disproportionally affects male American Indian/Alaska Natives (AI/AN). Suicide is particularly problematic among AI/AN firefighters who are more likely to report suicide ideation, planning, attempts, and risk compared to non-Hispanic white (NHW) firefighters. The aim of the current study was to compare non-Hispanic AI/AN firefighter and NHW firefighter suicide decedents by demographics and risk/precipitating factors using National Violent Death Reporting System data for 45 male non-Hispanic AI/AN firefighter and 588 male NHW firefighter decedents who died by suicide. Compared to NHW firefighter decedents, AI/AN firefighter decedents were significantly younger and had significantly higher odds of experiencing alcohol use problems and a recent death/suicide of a family member/friend. AI/AN firefighter decedents had significantly lower odds of documented mental health problems, documented diagnosis of depression/dysthymia, receipt of mental health treatment, or leaving a suicide note compared to NHW firefighter decedents. Results from this study may inform tailored suicide prevention and screening efforts among first responders with the goal of lowering suicide mortality among AI/AN firefighters and fire service as a whole.
Collapse
Affiliation(s)
- Michelle L Pennington
- Department of Public Health, Baylor University, Waco, TX, USA; Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA.
| | - Kelly R Ylitalo
- Department of Public Health, Baylor University, Waco, TX, USA
| | | | - Elizabeth Coe
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA
| | - Mariah Humphries
- George W. Truett Theological Seminary, Baylor University, Waco, TX, USA
| | - Suzy B Gulliver
- Warriors Research Institute, Baylor Scott & White Health, Waco, TX, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, Temple, TX, USA
| |
Collapse
|
8
|
Hicks T, Stillwater B, Koller K, Palmer L, Thomas T. Developing a culturally relevant physical activity guide for Alaska Native Head Start students in rural Alaska: the Got Neqpiaq? Study. Int J Circumpolar Health 2023; 82:2287791. [PMID: 38010792 PMCID: PMC10997299 DOI: 10.1080/22423982.2023.2287791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Concern was voiced by Elders, teachers, and parents that and playtime activities of the Head Start preschool programme were not aligned with the local Alaska Native culture in their communities.Methods: The Alaska Native Tribal Health Consortium partnered with 12 Head Start preschool programmes, administered by Rural Alaska Community Action Program in rural Alaska, to explore with community members Alaska Native value-based solutions to the concerns they raised. Local input was gathered via focus groups, interviews, and surveys.Results: We worked together with communities to create a physical activity guide specific to preschool-age children in the region. The guide includes activity descriptions, lesson plans, flash cards, and photos of traditional Alaska Native physical activities and games specific to the region. This manuscript details the community engagement process foundational to the physical activity guide's adoption and implementation.Conclusions: The processes by which the guide was developed were strength-based and participatory. Widespread community engagement and participation led to a guide that was readily adopted because the community had taken ownership of the content. The lessons learned have been invaluable in developing long-term community-based partnerships and in setting the precedent to further incorporate local/regional culture into rural Alaska Head Start programmes.
Collapse
Affiliation(s)
- Teresa Hicks
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Barb Stillwater
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Kathryn Koller
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| | - Lea Palmer
- Rural Alaska Community Action Program, Inc, Anchorage, AK, USA
| | - Timothy Thomas
- Alaska Native Tribal Health Consortium, Community Health Services Research Department, Anchorage, AK, USA
| |
Collapse
|
9
|
Hill CM, Nash SH, Hopkins SE, Boyer BB, OBrien DM, Bersamin A. Diet quality is positively associated with intake of traditional foods and does not differ by season in remote Yup'ik communities. Int J Circumpolar Health 2023; 82:2221370. [PMID: 37312577 PMCID: PMC10269404 DOI: 10.1080/22423982.2023.2221370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.
Collapse
Affiliation(s)
- Courtney M Hill
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
| | - Sarah H. Nash
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Scarlett E. Hopkins
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Bert B. Boyer
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Diane M. OBrien
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology and Wildlife, University of Fairbanks Alaska, Fairbanks, AK, USA
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska, Fairbanks, AK, USA
| |
Collapse
|
10
|
Hopkins SE, Orr E, Boyer BB, Thompson B. Culturally adapting an evidence-based intervention to promote a healthy diet and lifestyle for Yup'ik Alaska native communities. Int J Circumpolar Health 2023; 82:2159888. [PMID: 36544274 PMCID: PMC9788688 DOI: 10.1080/22423982.2022.2159888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Underserved populations are at increased risk for obesity and related cardiovascular disease, type 2 diabetes, and other chronic diseases. Lack of access to healthy foods, sedentary behaviour, and other social environmental factors contribute to disease risk. Yup'ik Alaska Native communities are experiencing lifestyle changes that are likely to affect their cardiometabolic risks. Barrera & Castro's Cultural Adaptation Framework was used to adapt an evidence-based intervention (EBI) originally designed for Latino communities for use in Yup'ik communities. Focus groups and key informant interviews were held in two Yup'ik communities. Major themes included causes of obesity, barriers and facilitators to healthy foods and physical activity, and intervention ideas. The adaptation process was guided by a Community Planning Group of Yup'ik women and included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. Two of the adapted educational modules were pilot tested. Involving community members as co-researchers in cultural adaptation is vital for an EBI to be effective in another population. Small group gatherings led by local lay health workers are culturally appropriate and may be an effective health promotion model in Yup'ik communities. Social environmental factors affecting healthy food availability and physical activity need further exploration.
Collapse
Affiliation(s)
- Scarlett E. Hopkins
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Eliza Orr
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Bert B. Boyer
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Beti Thompson
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
11
|
Smayda LC, Day GM, Redwood DG, Beans JA, Hiratsuka VY, Nash SH, Koller KR. Cancer Screening Prevalence among Participants in the Southcentral Alaska Education and Research towards Health (EARTH) Study at Baseline and Follow-Up. Int J Environ Res Public Health 2023; 20:6596. [PMID: 37623179 PMCID: PMC10454209 DOI: 10.3390/ijerph20166596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
Alaska Native communities are working to prevent cancer through increased cancer screening and early detection. We examined the prevalence of self-reported colorectal (CRC), cervical, and breast cancer screening among Alaska Native participants in the southcentral Alaska Education and Research toward Health (EARTH) study at baseline (2004-2006) and ten-year follow-up (2015-2017); participant characteristics associated with screening; and changes in screening prevalence over time. A total of 385 participants completed questionnaires at follow-up; 72% were women. Of those eligible for CRC screening, 53% of follow-up participants reported a CRC screening test within the past 5 years, significantly less than at baseline (70%) (p = 0.02). There was also a significant decline in cervical cancer screening between baseline and follow-up: 73% of women at follow-up vs. 90% at baseline reported screening within the past three years (p < 0.01). There was no significant difference in reported breast cancer screening between baseline (78%) and follow-up (77%). Colorectal and cervical cancer screening prevalence in an urban, southcentral Alaska Native cohort declined over 10 years of follow-up. Increased cancer screening and prevention are needed to decrease Alaska Native cancer-related morbidity and mortality.
Collapse
Affiliation(s)
- Lauren C. Smayda
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
| | - Gretchen M. Day
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
| | - Diana G. Redwood
- Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
| | | | - Vanessa Y. Hiratsuka
- Center for Human Development, College of Health, University of Alaska Anchorage, Anchorage, AK 99508, USA
| | - Sarah H. Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | | |
Collapse
|
12
|
Bogic M, Hebert LE, Evanson A, Wright BD, Petras A, Jansen K, Shaw J, Comtois KA, Nelson L. "Keep up the messages, sometimes it was a lifesaver": Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/ Alaska Native communities. Behav Res Ther 2023; 166:104333. [PMID: 37224700 PMCID: PMC10354378 DOI: 10.1016/j.brat.2023.104333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities' needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.
Collapse
Affiliation(s)
- Marija Bogic
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Luciana E Hebert
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Anna Evanson
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Barbara D Wright
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Anthippy Petras
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Kelley Jansen
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99577, USA.
| | - Jennifer Shaw
- Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99577, USA.
| | - Katherine Anne Comtois
- University of Washington, Box 359911, Harborview Medical Center, Seattle, WA, 98195, USA.
| | - Lonnie Nelson
- Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
| |
Collapse
|
13
|
Cunha-Cruz J, Hilgert JB, Harter C, Rothen ML, Hort K, Mallott E. Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams. Front Oral Health 2023; 4:1195736. [PMID: 37456360 PMCID: PMC10348878 DOI: 10.3389/froh.2023.1195736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.
Collapse
Affiliation(s)
- Joana Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Juliana Balbinot Hilgert
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Catherine Harter
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Marilynn L. Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Kim Hort
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
| | - Elizabeth Mallott
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
| |
Collapse
|
14
|
Engelking M, Marmor S, Burjak M, Hinojos M, Lloyd W, Switalla KM, Tuttle TM. Use of endocrine therapy for estrogen receptor-positive breast cancer among American Indians and Alaska natives. Breast Cancer Res Treat 2023; 198:187-195. [PMID: 36689093 DOI: 10.1007/s10549-022-06826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/30/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) women with estrogen receptor-positive (ER +) breast cancer have higher mortality compared to non-Hispanic whites (NHW). The purpose of this study is to compare rates of initiation of endocrine therapy (ET) between AI/AN and NHW and further determine survival outcomes for ER + breast cancer. METHODS We used the National Cancer Database to identify patients diagnosed with ER + breast cancer, stage I-III, between 2004 and 2017. Multivariable logistic regression was performed to determine factors associated with initiation of adjuvant ET. Overall survival was estimated using the Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS We identified a total of 771,619 patients (AI/AN, n = 2473; NHW, n = 769,146). Compared to NHW, AI/AN patients were more likely to live in rural areas, be younger, and have tumors that were higher grade, node positive, and larger. Initiation of adjuvant ET was high in both groups and not significantly different between AI/AN and NHW. Independent predictors of ET initiation included rural location, age, higher tumor grade, node-positive disease, larger tumor size, and progesterone receptor-positive status. Initiation of ET was significantly associated with improved overall survival among all patients. Overall survival was significantly worse among the AI/AN population. CONCLUSION AI/AN race was significantly and independently associated with worse overall survival after diagnosis of ER + breast cancer. We did not find a significant difference in the initiation of adjuvant ET between AI/AN and NHW. Exact reasons why AI/AN women with ER + breast cancer have higher mortality rates remain elusive but are probably multifactorial.
Collapse
Affiliation(s)
- Marta Engelking
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA.
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
- Center for Clinical Quality & Outcomes Discovery and Evaluation (C-QODE), Minneapolis, USA
| | - Mohamad Burjak
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Madeleine Hinojos
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Whitney Lloyd
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Kayla M Switalla
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55424, USA
| |
Collapse
|
15
|
Hebert LE, Fruhbauerova M, Evanson A, Bogic M, Petras A, Shaw J, Muller CJ, Nelson L, Comtois KA. Caring Texts, a strength-based, suicide prevention trial in 5 native communities: Research design and methods. Contemp Clin Trials 2022; 123:106966. [PMID: 36252937 DOI: 10.1016/j.cct.2022.106966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/20/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Despite their intrinsic strengths and resilience, some American Indian and Alaska Native (AI/AN) communities experience among the highest rates of suicide of any racial and ethnic group. Caring Contacts is one of the only interventions shown to reduce suicide in clinical trials, but it has not been tested in AI/AN settings. OBJECTIVE To compare the effectiveness of Enhanced Usual Care (control) to Enhanced Usual Care augmented with a culturally adapted version of Caring Contacts (intervention) for reducing suicidal ideation, suicide attempts, and suicide-related hospitalizations. METHODS We are implementing a single blind randomized controlled trial of Caring Contacts in five AI/AN communities across the country (South Dakota, Montana, Oklahoma, and Alaska). Eligible participants have to be (1) actively suicidal or have made a suicide attempt within the past year; (2) at least 18 years of age; (3) AI/AN; (4) able to speak and read English; (5) able to participate voluntarily; (6) willing to be contacted by text, email or postal mail; and (7) able to provide consent. Following consent and baseline assessment, participants are randomized to receive either Enhanced Usual Care alone, or Enhanced Usual Care with 12 months (25 messages) of culturally adapted Caring Contacts. Follow-up assessments are conducted at 12 and 18 months. CONCLUSIONS If effective, this study of Caring Contacts will inform programs to reduce suicide in the study communities as well as inform future research on Caring Contacts in other tribal settings. Modifications to continue the trial during the COVID-19 pandemic are discussed. CLINICAL TRIALS REGISTRATION NCT02825771.
Collapse
|
16
|
Fried R, Hahn M, Gillott L, Cochran P, Eichelberger L. Coping strategies and household stress/violence in remote Alaska: a longitudinal view across the COVID-19 pandemic. Int J Circumpolar Health 2022; 81:2149064. [PMID: 36419229 PMCID: PMC9704083 DOI: 10.1080/22423982.2022.2149064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has introduced novel stressors. Remote/rural communities have experienced additional difficulties, while also potentially benefitting from unique sources of resilience against such stressors. However, very little research has been conducted in remote/rural communities regarding coping and stress/violence. This study examines coping strategies and household stress/violence in remote Alaska communities across the pandemic through three online survey waves (November 2020-September 2021) (total n = 1,020). Across all waves, personal care was reported most frequently followed by social activities, religious activities, and traditional/subsistence activities. Substance use combined (alcohol, nicotine, marijuana) and seeking counselling were less frequently reported, with significant differences across gender and age categories. Less than 10% of individuals reported physical violence towards children and/or other adults within the household. Overall, these findings indicate that individuals are primarily relying on positive coping strategies to contend with additional stress brought into their lives by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ruby Fried
- University of Alaska Anchorage, Institute for Circumpolar Health Studies, AK, USA,CONTACT Ruby Fried University of Alaska Anchorage, Institute for Circumpolar Health Studies
| | - Micah Hahn
- University of Alaska Anchorage, Institute for Circumpolar Health Studies, AK, USA
| | - Lauren Gillott
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Laura Eichelberger
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| |
Collapse
|
17
|
Walch AK, Ohle KA, Koller KR, Alexie L, Lee F, Palmer L, Nu J, Thomas TK, Bersamin A. Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the "Got Neqpiaq?" Project. Int J Circumpolar Health 2022; 81:2024679. [PMID: 35037587 PMCID: PMC8765241 DOI: 10.1080/22423982.2021.2024679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.
Collapse
Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kathryn R. Koller
- Research Nurse Supervisor, Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation Research Department, Associate Research Coordinator, Bethel, Alaska, USA
| | - Flora Lee
- Epidemiology Research Nurse, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Lea Palmer
- Registered Dietitian Nutritionist, RurAL Cap Head Start, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K. Thomas
- Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| |
Collapse
|
18
|
Abstract
Culturally relevant health promotion is an opportunity to reduce health inequities in the cancer burden, and online learning is an emerging avenue for health promotion. To address a desire for synchronous online cancer education, a project team offered ten 1-hr cancer education webinars for Alaska's rural tribal health workers. The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. The evaluation of this community-based intervention included end-of-webinar surveys. Between February and April 2018, 41 surveys were completed by 11 unique participants. All participants reported that, as a result of the webinars, they planned both to change their own behavior to reduce cancer risk, and to talk with their patients more often about cancer prevention strategies such as screenings, physical activity, tobacco cessation, and eating healthy. While the webinars addressed desires for synchronous actions to support cancer learning, and led to intentions to positive change behaviors, the ten webinars engaged far fewer unique learners than the team's asynchronous cancer education modules. This experience may inform other cancer educators' efforts to develop, implement, and evaluate online learning opportunities. Despite the small numbers, these webinars resulted in increased learners' intent to reduce cancer risk behaviors, share cancer information, and improved learners' capacity to talk about cancer in their communities.
Collapse
Affiliation(s)
- Katie Cueva
- Institute of Social and Economic Research, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, AK, 99508, USA.
| | - Melany Cueva
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Laura Revels
- Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Michelle Hensel
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Mark Dignan
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
19
|
Hahn MB, Kuiper G, O'Dell K, Fischer EV, Magzamen S. Wildfire Smoke Is Associated With an Increased Risk of Cardiorespiratory Emergency Department Visits in Alaska. Geohealth 2021; 5:e2020GH000349. [PMID: 34036208 PMCID: PMC8137270 DOI: 10.1029/2020gh000349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/17/2021] [Indexed: 05/26/2023]
Abstract
Alaskan wildfires have major ecological, social, and economic consequences, but associated health impacts remain unexplored. We estimated cardiorespiratory morbidity associated with wildfire smoke (WFS) fine particulate matter with a diameter less than 2.5 μm (PM2.5) in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) during the 2015-2019 wildfire seasons. To estimate WFS PM2.5, we utilized data from ground-based monitors and satellite-based smoke plume estimates. We implemented time-stratified case-crossover analyses with single and distributed lag models to estimate the effect of WFS PM2.5 on cardiorespiratory emergency department (ED) visits. On the day of exposure to WFS PM2.5, there was an increased odds of asthma-related ED visits among 15-65 year olds (OR = 1.12, 95% CI = 1.08, 1.16), people >65 years (OR = 1.15, 95% CI = 1.01, 1.31), among Alaska Native people (OR = 1.16, 95% CI = 1.09, 1.23), and in Anchorage (OR = 1.10, 95% CI = 1.05, 1.15) and Fairbanks (OR = 1.12, 95% CI = 1.07, 1.17). There was an increased risk of heart failure related ED visits for Alaska Native people (Lag Day 5 OR = 1.13, 95% CI = 1.02, 1.25). We found evidence that rural populations may delay seeking care. As the frequency and magnitude of Alaskan wildfires continue to increase due to climate change, understanding the health impacts will be imperative. A nuanced understanding of the effects of WFS on specific demographic and geographic groups facilitates data-driven public health interventions and fire management protocols that address these adverse health effects.
Collapse
Affiliation(s)
- M. B. Hahn
- Institute for Circumpolar Health StudiesUniversity of Alaska‐AnchorageAnchorageAKUSA
| | - G. Kuiper
- Institute for Circumpolar Health StudiesUniversity of Alaska‐AnchorageAnchorageAKUSA
| | - K. O'Dell
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - E. V. Fischer
- Department of Atmospheric ScienceColorado State UniversityFort CollinsCOUSA
| | - S. Magzamen
- Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsCOUSA
| |
Collapse
|
20
|
Abstract
The population of the United States is aging and by 2045 it is projected that approximately 1 in every 6 Alaskans will be 65+. Delivering healthcare and meeting the needs of older Alaskans in their community is critical to supporting healthy aging and community sustainability. Alaska Native (AN) Elders are underserved with very few studies providing an emic perspective on their experience aging. This research opens the door and allows us a glimpse of the AN Elder experience of aging: the values, beliefs, and behaviors that allow them to age well. This study highlights the characteristics and activities of AN Elders in the Aleutian and Pribilof Islands to further develop the model of AN successful aging. There are many theories of aging and this study explores a cross-cultural understanding of gerotranscendence - the personal and interpersonal changes that result from successful aging or achieving Eldership. This study interviewed Elders in two communities of the Aleutian and Pribilof Islands region. Using 22 standardized questions based on the explanatory model, researchers facilitated discussion of what it means to be an Elder and age successfully. Employing thematic analysis, interview transcripts were analyzed for themes to organize the data. Themes were organized into 5 core elements of successful aging with specific emphasis on values, beliefs, and behaviors that were protective and helped them adapt to aging-related changes. Interview content, meaning, and themes support the four elements of the AN model of successful aging developed by Lewis (The Gerontologist, 51(4), 540-549, 2011): Mental and Emotional Wellbeing, Spirituality, Purposefulness and Engagement, and Physical Health. Elders' stories highlight the importance of reflection, personal growth, and psychosocial development. Elders who more strongly identified with their role in the community described how their perspective had changed and they shared stories that emphasized culture, connection to the land, and enjoyment of daily activities that resulted in increased life satisfaction. Elders provided clear evidence that they experienced aspects of gerotranscendence, which Tornstam (Journal of Aging Studies, 11(2), 143-154, 1997) categorized as the cosmic dimension, the self, and social and personal relationships. Elders adapting to aging-related changes and embracing their role as an Elder provided the greatest evidence of gerotranscendence - they developed new perspectives on life, took on new roles within the community, and experienced a shift in mindset that reinforced the importance of culture, tradition, and the Native Way of Life. This research allowed AN Elders to share their experiences, define successful aging, and expand the concept of Eldership to include changes in mindset, values, and relationships with themselves and others. The study is a framework to help us better understand the experiences of AN Elders aging successfully and the wisdom they wish to impart to others to help them learn to live healthy and meaningful lives.
Collapse
Affiliation(s)
- Erik S. Wortman
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Jordan P. Lewis
- University of Minnesota Medical School, 624 E. 1st. Street, Suite 201, Duluth, MN 55805 USA
| |
Collapse
|
21
|
Nash SH, Day G, Hiratsuka VY, Beans J, Redwood D, Holck P, Howard BV, Umans J, Koller KR. Ten-year weight gain is not associated with multiple cardiometabolic measures in Alaska EARTH study participants. Nutr Metab Cardiovasc Dis 2021; 31:403-410. [PMID: 33127251 PMCID: PMC7887000 DOI: 10.1016/j.numecd.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Alaska Native (AN) traditional lifestyle may be protective against chronic disease risk. Weight gain in adulthood has been linked to increases in chronic disease risk among other populations; yet, its impact among Alaska Native people has never been evaluated. We aimed to evaluate changes in obesity-related metrics over time, and determine associations of changes with cardiometabolic markers of chronic disease risk among AN people. METHODS AND RESULTS Study participants enrolled in the southcentral Alaska Education and Research Towards Health Study in 2004-2006 were invited to participate in a follow-up study conducted 2015-2017. Of the original 1320 participants, 388 completed follow-up health assessments consisting of multiple health surveys, anthropometric measurements, and cardiometabolic measures including blood sugars, blood lipids, and blood pressure. Differences in measurements between visits were determined and associations of weight change with cardiometabolic measures evaluated. Body mass index increased by 3.7 kg/m2 among men and 4.8 kg/m2 among women. Hip circumference (1.1 cm, p < 0.01) and waist circumference (0.7 cm, p < 0.01) increased among women; only waist circumference increased among men (1.6 cm, p < 0.01). Among men, there were no associations of weight change with cardiometabolic measures. Among women, there was an inverse association between weight gain and high-density lipoprotein cholesterol only (0.17 mg/dL (CI: -3.1, -0.03), p = 0.02). CONCLUSIONS While weight increase over a 10-year period was not associated with substantive changes in cardiometabolic measures among AN men, there was a decrease in high density lipid cholesterol associated with weight gain among AN women.
Collapse
Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
| | - Gretchen Day
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Julie Beans
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diana Redwood
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Peter Holck
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Barbara V Howard
- Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC, USA
| | - Jason Umans
- Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC, USA
| | - Kathryn R Koller
- Clinical and Research Services, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| |
Collapse
|
22
|
Leung J, Kennedy JL, Haberling DL, Apostolou A, Lanzieri TM. Congenital CMV-Coded Diagnosis Among American Indian and Alaska Native Infants in the United States, 2000-2017. J Immigr Minor Health 2020; 22:1101-1104. [PMID: 32424641 PMCID: PMC8829881 DOI: 10.1007/s10903-020-01024-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To assess prevalence of congenital cytomegalovirus (CMV)-coded diagnosis among American Indian/Alaska Native (AI/AN) infants who received Indian Health Service (IHS)-funded care during 2000-2017. Using data from the Indian Health Service National Data Warehouse, we identified AI/AN infants with congenital CMV-coded diagnosis, defined as presence of a diagnostic code for congenital CMV disease or CMV infection (International Classification of Diseases, Ninth Revision or Tenth Revision, Clinical Modification 771.1, 078.5, P35.1, B25.xx) within 90 days of life. We calculated prevalence of congenital CMV-coded diagnosis overall, by age at first CMV-coded diagnosis, and by geographical region. During 2000-2017, 54 (1.5/10,000) of 354,923 AI/AN infants had a congenital CMV-coded diagnosis; 32 (0.9/10,000) had their first CMV-coded diagnosis within 45 days of life, and 22 (0.6/10,000) between 46 and 90 days of life. Prevalence of congenital CMV-coded diagnosis varied by region (range 0.9/10,000 in Southern Plains to 3.7/10,000 in Alaska, P = 0.0038). Among the 54 infants with a congenital CMV-coded diagnosis, 48% had clinical signs such as jaundice, petechiae, or microcephaly, compared to 25% of 354,869 infants without a CMV-coded diagnosis (P < 0.01); and 1 (2%) vs. 277 (0.1%), respectively, died (P < 0.05). The prevalence of congenital CMV-coded diagnosis among AI/AN infants who received care at IHS facilities was slightly lower than in other studies based on health claims data and varied by geographical region.
Collapse
Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30333, USA.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, USA
- SciMetrika, LLC, McLean, VA, USA
| | - Tatiana M Lanzieri
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30333, USA
| |
Collapse
|
23
|
Abstract
The majority of the U.S. American Indian and Alaska Native (AI/AN) population live in rural areas, and are thus disproportionately affected by rural health issues. In addition, the AI/AN population has unique health characteristics resulting from a distinct cultural and sociopolitical history. A public health approach to both rural and Tribal health should include the medical specialty of preventive medicine, a unique physician specialty that combines both direct patient care and public health skills. To best prepare preventive medicine physicians for rural and Tribal practice, medical schools could recruit students from rural and Tribal areas and encourage them to pursue the specialty of preventive medicine. Additionally, preventive medicine residency training programs could establish clinical and public health practicum rotations in rural and Tribal areas, and develop curricula that address rural and Tribal health issues. Currently very few preventive medicine residency programs expressly state a mission to train physicians in rural or Tribal settings.
Collapse
Affiliation(s)
- Paul Jung
- Health Resources and Services Administration, Rockville, MD, United States of America.
| | - Donald K Warne
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States of America
| |
Collapse
|
24
|
Nelson A, Salkoski AJ, Richards B, Elliott W, Tan Cadogan C, Hirschfeld M, Day G, Holck P, Peterson J, Singleton R. Environmental Health Consults in Children Hospitalized with Respiratory Infections. J Community Health 2021; 46:324-33. [PMID: 32785871 DOI: 10.1007/s10900-020-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Indoor air pollutants contribute to respiratory infections and asthma exacerbations in children. Rural Alaska Native children experience some of the highest U.S. rates of respiratory hospitalizations, which are associated with lack of in-home running water, household crowding, and woodstove use. In our previous study, in-home education and modifications reduced respiratory symptoms, and medical visits. In this study, we evaluated the feasibility of providing in-hospital environmental health consults for parents/guardians of children < 5 years old hospitalized at the Alaska Native Medical Center with respiratory infections or asthma. Environmental health specialists conducted 92 in-hospital consults and mailed Healthy Homes Toolkits to households. Local housing authorities completed low-cost home modifications in 47 eligible households. Participants reported changes in household behaviors that were specifically addressed in the consult or included in the Toolkit (e.g. allergen-impermeable pillow covers). Reported respiratory symptoms were decreased at the 6-month follow-up. Over a 2 year period the median overall medical costs for respiratory illness in study children were $70,500. Children with in-home piped water had half the daily overall medical costs than children without in-home piped water ($74 compared to $144). In this study, we demonstrate that it is feasible to provide environmental consults, mail Toolkits, and arrange home modifications to the homes of children hospitalized with respiratory illness. These findings, along with the high costs of medical care for these children, suggest in-hospital environmental health consults are a cost-effective intervention.
Collapse
|
25
|
Nolen LD, Seeman S, Desnoyers C, DeByle C, Klejka J, Bruden D, Rudolph K, Gerber SI, Kim L, Langley G, Patel M, Englund J, Chu HY, Tiesinga J, Singleton R. Respiratory syncytial virus and influenza hospitalizations in Alaska native adults. J Clin Virol 2020; 127:104347. [PMID: 32334281 DOI: 10.1016/j.jcv.2020.104347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alaska Native (AN) infants from Yukon Kuskokwim Delta (YKD) have the highest U.S. infant hospitalization rate for respiratory syncytial virus (RSV). RSV can cause significant morbidity and mortality in adult populations, although the RSV burden in AN adults is unknown. Here we investigate RSV, influenza, and human metapneumovirus (hMPV) in hospitalized rural AN adults. METHODS YKD AN adults, hospitalized with acute respiratory illness between November 2016 and October 2018 were enrolled prospectively. Nasopharyngeal (NP) swabs were tested for RSV, influenza and hMPV using polymerase chain reaction. Hospitalization rates were calculated. RESULTS Of 251 patients who had an NP swab, RSV was detected in 8 (3.2 %), influenza in 31 (12.4 %), and hMPV in no patients. Weighted annual rates of lower respiratory tract infection (LRTI), RSV and influenza hospitalization were 192.0 (95 % CI: 176.5-208.4), 9.1 (6.0-13.3), and 42.2 (35.1-50.2) per 10,000. The most common discharge diagnosis was pneumonia (57.0 %), followed by chronic obstructive pulmonary disease (51.4 %). Ninety-eight percent (246/251) had a medical co-morbidity and 49.8 % (125/251) lived in a house with a smoker. Overall, 6.4 % (16/251) required mechanical ventilation, and 3.6 % (9/251) died during hospitalization. Only 35.7 % (66/185) of patients admitted during influenza season had received the annual influenza vaccine. DISCUSSION We examined adult LRTI, influenza, and RSV hospitalization rates in an AN population with high infant RSV hospitalization rates. While we confirmed a high rate of hospitalization from LRTIs and influenza, we did not find a high rate due to RSV or hMPV. Improving influenza vaccination rates, and addressing co-morbidities could reduce respiratory hospitalizations.
Collapse
Affiliation(s)
- Leisha D Nolen
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Center Rd, Anchorage, AK, 99508, United States.
| | - Sara Seeman
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Center Rd, Anchorage, AK, 99508, United States
| | - Christine Desnoyers
- Yukon Kuskokwim Health Corporation, Box 528, Bethel, AK, 99559, United States
| | - Carolynn DeByle
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Center Rd, Anchorage, AK, 99508, United States
| | - Joseph Klejka
- Yukon Kuskokwim Health Corporation, Box 528, Bethel, AK, 99559, United States
| | - Dana Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Center Rd, Anchorage, AK, 99508, United States
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4055 Tudor Center Rd, Anchorage, AK, 99508, United States
| | - Susan I Gerber
- Division of Viral Diseases, National Center for Infectious and Respiratory Disease (NCIRD), CDC, 1600 Clifton Rd, Atlanta, GA, 30329, United States
| | - Lindsay Kim
- Division of Viral Diseases, National Center for Infectious and Respiratory Disease (NCIRD), CDC, 1600 Clifton Rd, Atlanta, GA, 30329, United States
| | - Gayle Langley
- Division of Viral Diseases, National Center for Infectious and Respiratory Disease (NCIRD), CDC, 1600 Clifton Rd, Atlanta, GA, 30329, United States
| | - Manish Patel
- Influenza Division, National Center for Infectious and Respiratory Disease (NCIRD), CDC, 1600 Clifton Rd, Atlanta, GA, 30329, United States
| | - Janet Englund
- University of Washington, Seattle, WA, 98195, United States
| | - Helen Y Chu
- University of Washington, Seattle, WA, 98195, United States
| | - James Tiesinga
- Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK, 99508, United States
| | - Rosalyn Singleton
- Alaska Native Tribal Health Consortium, 4000 Ambassador Dr, Anchorage, AK, 99508, United States
| |
Collapse
|
26
|
Honeycutt AA, Khavjou O, Neuwahl SJ, King GA, Anderson M, Lorden A, Reed M. Incidence, deaths, and lifetime costs of injury among American Indians and Alaska Natives. Inj Epidemiol 2019; 6:44. [PMID: 31720199 PMCID: PMC6844062 DOI: 10.1186/s40621-019-0221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background In the United States, the mortality burden of injury is higher among American Indians and Alaska Natives (AI/AN) than any other racial/ethnic group, and injury contributes to considerable medical costs, years of potential life lost (YPLL), and productivity loss among AI/AN.This study assessed the economic burden of injuries for AI/AN who are eligible for services through Indian Health Service, analyzing direct medical costs of injury for Indian Health Service's users and years of potential life lost (YPLL) and the value of productivity losses from injury deaths for AI/AN in the Indian Health Service population. Methods Injury-related lifetime medical costs were estimated for Indian Health Service users with medically treated injuries using data from the 2011-2015 National Data Warehouse. Productivity costs and YPLL were estimated using data on injury-related deaths among AI/AN in Indian Health Service's 2008-2010 service population. Costs were reported in 2017 U.S. dollars. Results The total estimated costs of injuries per year, including injuries among Indian Health Service users and productivity losses from injury-related deaths, were estimated at $4.5 billion. Lifetime medical costs to treat annual injuries among Indian Health Service users were estimated at $549 million, with the largest share ($131 million) going toward falls, the most frequent injury cause. Total estimated YPLL from AI/AN injury deaths in Indian Health Service's service population were 106,400. YPLL from injury deaths for men (74,000) were 2.2 times YPLL for women (33,000). Productivity losses from all injury-related deaths were $3.9 billion per year. The highest combined lifetime medical and mortality costs were for motor vehicle/traffic injuries, with an estimated cost of $1.6 billion per year. Conclusions Findings suggest that targeted injury prevention efforts by Indian Health Service likely contributed to lower rates of injury among AI/AN, particularly for motor vehicle/traffic injuries. However, because of remaining disparities in injury-related outcomes between AI/AN and all races in the United States, Indian Health Service should continue to monitor changes in injury incidence and costs over time, evaluate the impacts of previous injury prevention investments on current incidence and costs, and identify additional injury prevention investment needs.
Collapse
Affiliation(s)
- Amanda A Honeycutt
- 1RTI International, Public Health Economics Program, 3040 Cornwallis Road, Durham, NC 27709 USA
| | - Olga Khavjou
- 1RTI International, Public Health Economics Program, 3040 Cornwallis Road, Durham, NC 27709 USA
| | - Simon J Neuwahl
- 1RTI International, Public Health Economics Program, 3040 Cornwallis Road, Durham, NC 27709 USA
| | - Grant A King
- 1RTI International, Public Health Economics Program, 3040 Cornwallis Road, Durham, NC 27709 USA
| | | | - Andrea Lorden
- 3Independent Health Services Research Consultant and Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Michael Reed
- 4Indian Health Service, Division of Environmental Health Services, Rockville, MD USA
| |
Collapse
|
27
|
Conway AA, Gerry JM, Sacco F, Wren SM. High Prevalence of Adenomatous Polyps in Alaska Native People Aged 40-49 years. J Surg Res 2019; 243:524-530. [PMID: 31377493 DOI: 10.1016/j.jss.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/02/2019] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although colorectal cancer occurs earlier in life and at twice the frequency in Alaska Native (AN) people compared with the general population, the colorectal polyp burden in this group has not been quantified. In addition, an appropriate age for initial screening in ANs has not been defined. MATERIALS AND METHODS A retrospective chart review of 766 AN people who had screening colonoscopy from 2015 to 2016 was performed. The polyp burden in patients aged 40-49 y was compared with that in those aged 50-59 y in both the AN and the general US populations. RESULTS In total, 345 adenomas were removed: 121 (35%) from 40- to 49-year-olds and 224 (65%) from 50- to 59-year-olds. Twenty-six percent of AN people aged 40 y to 49 y and 40% of AN people aged 50 to 59 y had at least one adenoma. Low- and high-risk adenomas were significantly less frequent in the younger group (22% versus 29%, P = 0.048; 9.2% versus 15%, P = 0.035; respectively). Advanced adenomas were also less frequent in the younger group, although not statistically significant. Polyp histology, size, location, and morphology did not differ significantly between groups. CONCLUSIONS The adenoma and advanced adenoma prevalence in 40- to 49-year-old AN people is high, suggesting colorectal cancer screening should begin at age 40 y in ANs.
Collapse
Affiliation(s)
- Alison A Conway
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Jon M Gerry
- Department of Surgery, Alaska Native Medical Center, Anchorage, Alaska
| | - Frank Sacco
- Department of Surgery, Alaska Native Medical Center, Anchorage, Alaska
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Surgery, Palo Alto Veterans Health Care System, Palo Alto, California.
| |
Collapse
|
28
|
Woodbury RB, Beans JA, Hiratsuka VY, Burke W. Data Management in Health-Related Research Involving Indigenous Communities in the United States and Canada: A Scoping Review. Front Genet 2019; 10:942. [PMID: 31649725 PMCID: PMC6796238 DOI: 10.3389/fgene.2019.00942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Multiple factors, including experiences with unethical research practices, have made some Indigenous groups in the United States and Canada reticent to participate in potentially beneficial health-related research. Yet, Indigenous peoples have also expressed a willingness to participate in research when certain conditions related to the components of data management-including data collection, analysis, security and storage, sharing, dissemination, and withdrawal-are met. A scoping review was conducted to better understand the terms of data management employed in health-related research involving Indigenous communities in the United States and Canada. Methods: PubMed, Embase, PsychINFO, and Web of Science were searched using terms related to the populations and topics of interest. Results were screened and articles deemed eligible for inclusion were extracted for content on data management, community engagement, and community-level research governance. Results: The search strategy returned 734 articles. 31 total articles were extracted, of which nine contained in-depth information on data management and underwent detailed extraction. All nine articles reported the development and implementation of data management tools, including research ethics codes, data-sharing agreements, and biobank access policies. These articles reported that communities were involved in activities and decisions related to data collection (n=7), data analysis (n=5), data-sharing (n=9), dissemination (n=7), withdrawal (n=4), and development of data management tools (n=9). The articles also reported that communities had full or shared ownership of (n=5), control over (n=9), access to (n=1), and possession of data (n=5). All nine articles discussed the role of community engagement in research and community-level research governance as means for aligning the terms of data management with the values, needs, and interests of communities. Conclusions: There is need for more research and improved reporting on data management in health-related research involving Indigenous peoples in the United States and Canada. Findings from this review can provide guidance for the identification of data management terms and practices that may be acceptable to Indigenous communities considering participation in health-related research.
Collapse
Affiliation(s)
- R Brian Woodbury
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Julie A Beans
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| |
Collapse
|
29
|
Zamora-Kapoor A, Sinclair K, Nelson L, Lee H, Buchwald D. Obesity risk factors in American Indians and Alaska Natives: a systematic review. Public Health 2019; 174:85-96. [PMID: 31326761 DOI: 10.1016/j.puhe.2019.05.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/08/2019] [Accepted: 05/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages. STUDY DESIGN We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American. METHODS We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs. RESULTS Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity. CONCLUSIONS Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.
Collapse
Affiliation(s)
- A Zamora-Kapoor
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
| | - K Sinclair
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - L Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - H Lee
- Department of Sociology, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - D Buchwald
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA 98101, USA; College of Medicine, Washington State University, Spokane, WA 99202, USA
| |
Collapse
|
30
|
O'Keefe VM, Hartmann WE. Working Together to Advance Indigenous Interests with Community Psychology. Am J Community Psychol 2019; 64:185-190. [PMID: 31460674 DOI: 10.1002/ajcp.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Victoria M O'Keefe
- Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William E Hartmann
- School of Interdisciplinary Arts & Sciences, University of Washington Bothell, Bothell, WA, USA
| |
Collapse
|
31
|
Woodbury RB, Ketchum S, Hiratsuka VY, Spicer P. Health-Related Participatory Research in American Indian and Alaska Native Communities: A Scoping Review. Int J Environ Res Public Health 2019; 16:E2969. [PMID: 31426579 PMCID: PMC6719130 DOI: 10.3390/ijerph16162969] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022]
Abstract
A scoping review was conducted to assess the state of the literature on health-related participatory research involving American Indian and Alaska Native communities. Online databases were searched for relevant articles published between 1/1/2000 and 5/31/2017. 10,000+ data points relevant to community-level engagement in and regulation of research, community research capacity and cultural adaptation were extracted from 178 articles. Community engagement varied across study components: 136 (76%) articles reported community participation in research-related meetings and other events and 49 (27%) articles reported community involvement in initiation of research. 156 (88%) articles reported use of community-level tools to guide or regulate research. 93 (52%) articles reported that community members received research-related training. 147 (82%) articles described some type of cultural adaptation. Across all articles, data points on community engagement were not reported in 3061 (40%) out of 7740 cases. Findings suggest a need for increased community engagement in early stages of the research process and for reporting guidelines for participatory research involving American Indian and Alaska Native communities. There is also need to further existing research on the impact of different components of participatory research on process and outcome measures and to develop funding mechanisms that account for the time and resource intensive nature of participatory research.
Collapse
Affiliation(s)
- R Brian Woodbury
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA.
| | - Scott Ketchum
- University of Oklahoma, 5 Partners Place, Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
| | - Vanessa Y Hiratsuka
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, 5 Partners Place, 201 Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
| |
Collapse
|
32
|
Kegler MC, Anderson K, Bundy LT, Knauf D, Halfacre J, Escoffery C, Cramblit A, Henderson P. A Qualitative Study about Creating Smoke-free Home Rules in American Indian and Alaska Native Households. J Community Health 2019; 44:684-693. [PMID: 31025142 PMCID: PMC6612306 DOI: 10.1007/s10900-019-00666-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Smoke-free homes can reduce exposure to secondhand smoke (SHS) and support smoking cessation. The current study seeks to understand perspectives, including barriers and facilitators, on smoke-free homes among five American Indian/Alaska Native (AI/AN) communities. Guided by a national work group of tribal partners, ten focus groups were conducted with AI/AN adult smokers and nonsmokers (n = 95) in Alaska, California, Michigan and Oklahoma, stratified by smoking status. The majority of participants lived in single unit detached homes (70.5%). Most of the nonsmokers had a smoke-free home rule (92.9%) and a majority of smokers did as well (64.7%). The most common reasons for smoke-free home rules were protecting children and grandchildren, including children with health problems. Challenges to a smoke-free home included weather and visitors who smoked, along with the inconvenience of going outside, the habit of smoking inside, the need to watch a young child, safety concerns, and smokers who break the rules. Respecting rules and respecting elders emerged as important themes. Traditional use of tobacco in the home was viewed as quite distinct from recreational or everyday use. Over half (58.2%) reported never using tobacco for ceremonial, prayer or traditional reasons in their homes. Given unique considerations for the adoption of smoke-free homes in AI/AN communities, particularly regarding the use of sacred tobacco for traditional, ceremonial, or medicinal purposes, it is important to learn which barriers and facilitators are similar to the general population and which may be unique to tribal communities in the U.S.
Collapse
Affiliation(s)
- Michelle C Kegler
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA.
| | - Katherine Anderson
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Lucja T Bundy
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | | | - June Halfacre
- Cherokee Nation, 17675 S Muskogee, P. O. Box 948, Tahlequah, OK, 74464, USA
| | - Cam Escoffery
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Andre Cramblit
- United Indian Health Services: Potawot Health Village, 1600 Weeot Way, Arcata, CA, 95521, USA
| | - Patricia Henderson
- Black Hills Center for American Indian Health, 701 St. Joseph Street, Suite 204, Rapid City, SD, 57701, USA
| |
Collapse
|
33
|
Anderson KM, Kegler MC, Bundy LT, Henderson P, Halfacre J, Escoffery C. Adaptation of a brief smoke-free homes intervention for American Indian and Alaska Native families. BMC Public Health 2019; 19:981. [PMID: 31337379 PMCID: PMC6651935 DOI: 10.1186/s12889-019-7301-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The goal of adaptation is to maintain the effectiveness of the original intervention by preserving the core elements that account for its success while delivering an intervention that is tailored to the new community and/or cultural context. The current study describes the process of adapting an evidence-based smoke-free homes (SFH) intervention for use in American Indian/Alaska Native (AI/AN) households. METHODS We followed a systematic adaptation process. We first assessed the community through focus groups coordinated in collaboration with tribal partners. Because our team included the original developers of the intervention, the steps of understanding the intervention, selecting the intervention and consulting with experts were simplified. Additional steps included consulting with stakeholders through a national work group and collaboratively deciding what needed adaptation. RESULTS A number of key themes pertinent to the adaptation of the SFH intervention were identified in the focus groups. These included the gravity of messaging about commercial tobacco use; respect, familialism, and intergenerationalism; imagery, including significant symbolism, colors, and representative role models; whether and how to address traditional tobacco; and, barriers to a SFH not adequately addressed in the original materials. CONCLUSIONS Adaptation of an intervention to create smoke-free homes in AI/AN families necessitated both surface structure changes such as appearance of role models and deep structure changes that addressed core values, and beliefs and traditions.
Collapse
Affiliation(s)
- Katherine M. Anderson
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Lucja T. Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | | | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| |
Collapse
|
34
|
Livingston R, Daily RS, Guerrero APS, Walkup JT, Novins DK. No Indians to Spare: Depression and Suicide in Indigenous American Children and Youth. Child Adolesc Psychiatr Clin N Am 2019; 28:497-507. [PMID: 31076123 DOI: 10.1016/j.chc.2019.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article summarizes current knowledge and consensus about depression and suicide among the indigenous young people of the United States. American Indians represent more than 500 tribes and also vary among settings-reservations, urban, suburban, and rural-but as a group, remain at high risk for suicide and possibly for depressive syndromes. Particular risk factors and correlates, as well as approaches to treatment, are discussed.
Collapse
|
35
|
Emmett SD, Robler SK, Wang NY, Labrique A, Gallo JJ, Hofstetter P. Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska. BMJ Open 2019; 9:e023078. [PMID: 30782695 PMCID: PMC6340015 DOI: 10.1136/bmjopen-2018-023078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The population in rural Alaska experiences a disproprionately high burden of infection-mediated hearing loss. While the state mandates school hearing screening, many children with hearing loss are not identified or are lost to follow-up before ever receiving treatment. A robust, tribally owned healthcare system exists in Alaska, but children with hearing loss must first be identified and referred for existing infrastructure to be used. This trial will evaluate a new school hearing screening and referral process in rural Alaska, with the goal of improving timely identification and treatment of childhood hearing loss. METHODS AND ANALYSIS Comparative effectiveness community randomised trial testing digital innovations to improve school hearing screening and referral in 15 communities in the Norton Sound region of northwest Alaska, with data collection from October 2017 to February 2020. All children (K-12) attending school in Bering Strait School District with parental informed consent and child assent will be eligible (target recruitment n=1500). Participating children will undergo both the current school hearing screen and new mobile health (mHealth) screen, with screening test validity evaluated against an audiometric assessment. Communities will be cluster randomised to continue the current primary care referral process or receive telemedicine referral for follow-up diagnosis and treatment. The primary outcome will be time to International Statistical Classification of Diseases, 10th Revision, ear/hearing diagnosis from screening date, measured in days. Secondary outcomes will include: sensitivity and specificity of current school and mHealth screening protocols measured against a benchmark audiometric assessment (air and bone conduction audiometry, tympanometry and digital otoscopy); hearing loss prevalence; hearing-related quality of life; and school performance (AIMSweb). Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Boards of Alaska Area, Norton Sound and Duke University and is registered on clinicaltrials.gov. Results will be distributed with equal emphasis on scientific and community dissemination. TRIAL REGISTRATION NUMBER NCT03309553; Pre-results.
Collapse
Affiliation(s)
- Susan D Emmett
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Departments of Biostatistics and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain Labrique
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Food insecurity is a public health concern. The pillars of food security include food access, availability and utilisation. For some indigenous peoples, the pillars may focus on traditional foods. OBJECTIVE To conduct a scoping review on traditional foods and food security in Alaska. DESIGN Google Scholar and the High North Research Documents were used to search for relevant primary research using the following terms: “traditional foods”, “food security”, “access”, “availability”, “utilisation”, “Alaska”, “Alaska Native” and “indigenous”. RESULTS Twenty four articles from Google Scholar and four articles from the High North Research Documents met the inclusion criteria. The articles revealed three types of research approaches, those that quantified traditional food intake (n=18), those that quantified food security (n=2), and qualitative articles that addressed at least one pillar of food security (n=8). CONCLUSIONS Studies that estimate the prevalence of traditional food insecurity in Alaska are virtually absent from the literature. Instead most studies provide a review of factors related to food security. Research investigating dietary intake of traditional foods is more prevalent. Future research should include direct measurements of traditional food intake and food security to provide a more complete picture of traditional food security in Alaska.
Collapse
Affiliation(s)
- Amanda Walch
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Andrea Bersamin
- Department of Biology & Wildlife, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Philip Loring
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Rhonda Johnson
- Department of Health Sciences, University of Alaska Anchorage, Anchorage, AK, USA
| | - Melissa Tholl
- Department of Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, AK, USA
| |
Collapse
|
37
|
Lewis JP, Boyd K, Allen J, Rasmus S, Henderson T. "We Raise our Grandchildren as our Own:" Alaska Native Grandparents Raising Grandchildren in Southwest Alaska. J Cross Cult Gerontol 2018; 33:265-286. [PMID: 29797108 DOI: 10.1007/s10823-018-9350-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study explores continuity and change in the roles of rural Alaska Native grandparents, describing their importance in contemporary Yup'ik social life and structure. The study is distinctive in its focus on the experiences of Yup'ik grandparents who are primary caregivers raising their grandchildren in Southwest Alaska. Qualitative data were gathered using a semi-structured interview from 20 Yup'ik grandparents, ages 46 to 95, who raised their grandchildren as the primary caregiver for at least one year. Content analysis was used to establish a culturally grounded understanding of the role of a grandparent raising grandchildren and meanings of these roles to Yup'ik grandparents. Findings reveal areas of continuity and change in the role and place of grandparents in Yup'ik families and communities. Important continuities persist in the role of Yup'ik grandparents, who continue to be a vital resource within their families and communities. As in the past, the grandparent role is essential in passing down cultural knowledge, upholding traditional Yup'ik values and teachings, and facilitating development of a strong and healthy cultural identity among youth. However, significant change has taken place within Yup'ik communities as a result of Western colonization. Grandparent roles are also shifting and expanding as a result of these changes, as part of an adaptive community response to ensure the safety and well-being of youth during times of great change and disruption.
Collapse
Affiliation(s)
- Jordan P Lewis
- UAA WWAMI School of Medical Education, 3211 Providence Drive, HSB 301, Anchorage, AK, 99508, USA.
| | - Keri Boyd
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - James Allen
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Stacy Rasmus
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Tammy Henderson
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, USA
| |
Collapse
|
38
|
Au NT, Ryman T, Rettie AE, Hopkins SE, Boyer BB, Black J, Philip J, Yracheta J, Fohner AE, Reyes M, Thornton TA, Austin MA, Thummel KE. Dietary Vitamin K and Association with Hepatic Vitamin K Status in a Yup'ik Study Population from Southwestern Alaska. Mol Nutr Food Res 2018; 62:10.1002/mnfr.201700746. [PMID: 29094808 PMCID: PMC5803412 DOI: 10.1002/mnfr.201700746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/10/2017] [Indexed: 01/15/2023]
Abstract
SCOPE The relationship between dietary vitamin K and plasma PIVKA-II concentration, a biomarker of hepatic vitamin K status, in a Yup'ik study population in southwestern Alaska is investigated. METHODS AND RESULTS A total of 659 male and female, self-reported Yup'ik people, ≥14 years of age, were enrolled. Blood is collected for genotyping and plasma PIVKA-II biomarker analysis. A Yup'ik-specific dietary food frequency questionnaire is used to assess vitamin K intake. Among the participants, 22% report not consuming foods rich in vitamin K during the past year and 36% have a PIVKA-II concentration ≥ 2 ng mL-1 , indicating vitamin K insufficiency. The odds of an elevated PIVKA-II concentration are 33% lower in individuals reporting any versus no consumption of vitamin-K-rich foods. The association is significant after adjusting for CYP4F2*3 genotype. Tundra greens are high in vitamin K1 content, but an exploratory analysis suggests that subsistence meat sources have a greater effect on vitamin K status. CONCLUSIONS A substantial proportion of the Yup'ik population exhibits vitamin K insufficiency, which is associated with low consumption of vitamin K rich foods and which might affect an individual's response to anticoagulant drugs such as warfarin that target the vitamin K cycle.
Collapse
Affiliation(s)
- Nicholas T Au
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA
| | - Tove Ryman
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Allan E Rettie
- Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA
| | - Scarlett E Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Bert B Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Jynene Black
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Jacques Philip
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Joseph Yracheta
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| | - Alison E Fohner
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
| | - Morayma Reyes
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Melissa A Austin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Kenneth E Thummel
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
| |
Collapse
|
39
|
Boden-Albala B, Allen J, Roberts ET, Bulkow L, Trimble B. Ascertainment of Alaska Native Stroke Incidence, 2005-2009: Lessons for Assessing the Global Burden of Stroke. J Stroke Cerebrovasc Dis 2017; 26:2019-2026. [PMID: 28716585 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke is a critical public health issue in the United States and globally. System models to optimally capture stroke incidence in rural and culturally diverse communities are needed. The epidemiological transition to a western lifestyle has been associated with an increased burden of vascular risk factors among Alaska Native (AN) people. The burden of stroke in AN communities remains understudied. METHODS The Alaska Native Stroke Registry (ANSR) was designed to screen and capture all stroke cases between 2005 and 2009 through its integration into the existing single-payer Alaska Tribal Health System infrastructure. Registry staff received notification each time stroke International Classification of Diseases, Ninth Revision codes (430-436) were initiated anywhere in the system. Trained chart abstractors reviewed medical records to document incident strokes among AN patients, which were adjudicated. RESULTS Between October 2005 and October 2009, over 2100 alerts were screened identifying 514 unique stroke cases, of which 372 were incident strokes. The average annual incidence of stroke (per 100,000) among AN adults was 190.6: 219.2 in men and 164.7 in women. Overall, the ischemic stroke incidence rate was 148.5 per 100,000 with men (184.6) having higher ischemic rates per 100,000 than women (118.3). Men have higher rates of ischemic stroke at all ages, whereas older women experienced higher rates of hemorrhagic strokes over the age of 75 years. CONCLUSIONS We report a high rate of overall stroke, 190.6 per 100,000. The ANSR methods and findings have implications for other indigenous populations and for global health populations currently undergoing similar epidemiological transitions.
Collapse
Affiliation(s)
- Bernadette Boden-Albala
- Division of Social Epidemiology, College of Global Public Health, New York University, New York, New York; Department of Neurology, New York University, New York, New York; College of Dentistry, New York University, New York, New York.
| | - James Allen
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth, Minnesota; Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Eric T Roberts
- Division of Social Epidemiology, College of Global Public Health, New York University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lisa Bulkow
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Brian Trimble
- Department of Neurology, Alaska Native Medical Center, Anchorage, Alaska
| |
Collapse
|
40
|
Jernigan VBB, Huyser KR, Valdes J, Simonds VW. Food Insecurity among American Indians and Alaska Natives: A National Profile using the Current Population Survey-Food Security Supplement. J Hunger Environ Nutr 2016; 12:1-10. [PMID: 28491205 DOI: 10.1080/19320248.2016.1227750] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Food insecurity increases the risk for obesity, diabetes, hypertension, and cancer-conditions highly prevalent among American Indians and Alaska Natives (AI/ANs). Using the Current Population Survey Food Security Supplement, we analyzed the food insecurity trends of AI/ANs compared to other racial and ethnic groups in the United States from 2000 to 2010. From 2000 to 2010, 25% of AI/ANs remained consistently food insecure and AI/ANs were twice as likely to be food insecure compared to whites. Urban AI/ANs were more likely to experience food insecurity than rural AI/ANs. Our findings highlight the need for national and tribal policies that expand food assistance programs; promote and support increased access to healthy foods and community food security, in both rural and urban areas; and reduce the burden of diet-related disparities on low-income and racial/ethnic minority populations.
Collapse
Affiliation(s)
- Valarie Blue Bird Jernigan
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, Oklahoma, USA
| | - Kimberly R Huyser
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jimmy Valdes
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Vanessa Watts Simonds
- Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
| |
Collapse
|
41
|
Driscoll DL, Hiratsuka V, Johnston JM, Norman S, Reilly KM, Shaw J, Smith J, Szafran QN, Dillard D. Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation. Ann Fam Med 2013; 11 Suppl 1:S41-9. [PMID: 23690385 PMCID: PMC3707246 DOI: 10.1370/afm.1474] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. METHODS We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. RESULTS Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. CONCLUSIONS All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments.
Collapse
Affiliation(s)
- David L Driscoll
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, 3211 Providence Dr, DPL 404, Anchorage, AK 99508, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|