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Wexler L, White LA, O'Keefe VM, Rasmus S, Haroz EE, Cwik MF, Barlow A, Goklish N, Elliott E, Pearson CR, Allen J. Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities. Arch Suicide Res 2024:1-16. [PMID: 38240632 DOI: 10.1080/13811118.2023.2300321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.
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Shukla R, Turner BJ, Ramos GG, Love M, D'Isabella J, Soto C. American Indian and Alaska Native substance use treatment: Barriers and facilitators according to an implementation framework. J Subst Use Addict Treat 2023; 155:209095. [PMID: 37277023 DOI: 10.1016/j.josat.2023.209095] [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] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) and overdose deaths are higher in the American Indian and Alaska Native (AIAN) population than in other racial/ethnic groups. Multi-level gaps hinder SUD treatment for AIAN patients. Few studies have engaged front-line clinicians and administrators of SUD treatment programs serving AIAN patients to identify barriers and facilitators to improve the implementation of effective treatment. METHODS We conducted key informant interviews with a diverse sample of providers and administrators of SUD treatment programs across California regarding barriers and facilitators to treatment for AIAN patients. An AIAN-majority community advisory board (CAB) guided the development of an interview guide and helped to recruit respondents from five types of SUD programs statewide. Using ATLAS.ti, the research team coded interviews and classified emergent themes as barriers and facilitators related to Outer, Inner, and Individual domains of the Consolidated Framework for Implementation Research (CFIR). RESULTS Representatives of 13 of 15 invited SUD treatment programs participated and 9 of the 13 interviewed self-identified as AIAN. Related to Outer Setting barriers from coded interviews, a dominant barrier was policies that defund or underfund SUD treatment, especially detoxification centers. Outer Setting facilitators included consistent Indian Health Service (IHS) eligibility criteria, judicial system connections for direct treatment access, and community programs advocating SUD treatment. Key themes related to barriers for the Inner Setting were limited bed capacity, poor coordination of intake and care, and lack of telehealth technology. Facilitators integrated mental health, linkage to external resources, and culturally centered care. Individual-level barriers were negative attitudes such as SUD stigma, distrust of governmental programs, and lack of transportation while individual engagement was facilitated by programs addressing negative attitudes and providing telemedicine for remote care. CONCLUSION The public health threat of SUD for the AIAN population mandates the implementation of interventions and policies that facilitate care. This qualitative study with primarily AIAN clinical leaders of SUD treatment highlights opportunities to improve care at multiple CFIR levels, focusing on capacity, coordination, culturally congruent care, and community initiatives to promote engagement.
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Affiliation(s)
- Rit Shukla
- University of Southern California Price School of Public Policy, 650 Childs Way, Los Angeles, CA 90089, United States of America
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA 90033, United States of America.
| | - Guadalupe G Ramos
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Morgan Love
- California Consortium for Urban Indian Health, 1016 Lincoln Blvd #111, San Francisco, CA 94129, United States of America
| | - Julia D'Isabella
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
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Rhodes KL, Echo-Hawk A, Lewis JP, L Cresci V, E Satter D, A Dillard D. Centering Data Sovereignty, Tribal Values, and Practices for Equity in American Indian and Alaska Native Public Health Systems. Public Health Rep 2023:333549231199477. [PMID: 37864519 DOI: 10.1177/00333549231199477] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Affiliation(s)
| | - Abigail Echo-Hawk
- Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Vanesscia L Cresci
- National Telecommunications and Information Administration, US Department of Commerce, Washington, DC, USA
| | - Delight E Satter
- Tribal Public Health Law Program, Center for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise A Dillard
- Institute for Research to Advance Community Health, Washington State University, Seattle, WA, USA
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Stotz SA, Hebert LE, Charron-Prochownik D, Scarton L, Moore KR, Sereika SM. Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females. Transl Behav Med 2023; 13:645-665. [PMID: 37353950 PMCID: PMC10496435 DOI: 10.1093/tbm/ibad029] [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] [Indexed: 06/25/2023] Open
Abstract
American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.
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Affiliation(s)
- Sarah A Stotz
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health (IREACH) at the Elson S. Floyd College of Medicine at Washington State University, Seattle, WA, USA
| | - Denise Charron-Prochownik
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Lisa Scarton
- University of Florida, School of Nursing, Department of Family, Community and Health Systems Science, Gainsville, FL, USA
| | - Kelly R Moore
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Susan M Sereika
- Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Reece J, Skelton-Wilson S, Mitchell-Box K, Groom A, Thomas C. Building a Roadmap to Health Equity: Strengthening Public Health Infrastructure in Indian Country. Public Health Rep 2023; 138:7S-13S. [PMID: 37565292 PMCID: PMC10515983 DOI: 10.1177/00333549231186579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Affiliation(s)
- Julianna Reece
- Division of Population Health, Centers for Disease Control and Prevention, Albuquerque, NM, USA
| | | | - Kristen Mitchell-Box
- Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center, Anchorage, AK, USA
| | - Amy Groom
- Healthy Tribes, Centers for Disease Control and Prevention, Albuquerque, NM, USA
| | - Craig Thomas
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Neel LC, McCollum JT. Indian Health Service Support for Tribal Epidemiology Centers. Public Health Rep 2023; 138:14S-16S. [PMID: 36891832 PMCID: PMC10515985 DOI: 10.1177/00333549231151672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Lisa C Neel
- Division of Epidemiology and Disease Prevention, Office of Public Health Support, Indian Health Service, Rockville, MD, USA
| | - Jeffrey T McCollum
- Division of Epidemiology and Disease Prevention, Office of Public Health Support, Indian Health Service, Rockville, MD, USA
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Cassidy LD, Kenyon D, Ritchey J, Becenti D, Ayala A, Prather T, Mitchell-Box K. Tribal Epidemiology Centers: At the Forefront of American Indian/Alaska Native Public Health. Public Health Rep 2023; 138:3S-6S. [PMID: 37599446 PMCID: PMC10515978 DOI: 10.1177/00333549231193439] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Laura D Cassidy
- Department of Epidemiology and Social Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - DenYelle Kenyon
- Department of Public Health and Health Sciences, University of South Dakota, Vermillion, SD, USA
| | - Jamie Ritchey
- Inter Tribal Council of Arizona, Inc, Tribal Epidemiology Center, Phoenix, AZ, USA
| | - Delores Becenti
- Navajo Department of Health, Navajo Epidemiology Center, Window Rock, AZ, USA
| | - Aurimar Ayala
- California Rural Indian Health Board Inc, California Tribal Epidemiology Center, Roseville, CA, USA
| | - Tracy Prather
- Southern Plains Tribal Health Board, Oklahoma Area Tribal Epidemiology Center, Oklahoma City, OK, USA
| | - Kristen Mitchell-Box
- Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center, Anchorage, AK, USA
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Asher BlackDeer A. VIOLENCE, TRAUMA, AND COLONIALISM: A STRUCTURAL APPROACH TO UNDERSTANDING THE POLICY LANDSCAPE OF INDIGENOUS REPRODUCTIVE JUSTICE. J Trauma Dissociation 2023:1-18. [PMID: 37183426 DOI: 10.1080/15299732.2023.2212402] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Indigenous peoples in the U.S. have the highest rates of violence against women, disproportionate representation in the child welfare system, and exorbitant amounts of traumatic injuries among all ethnic groups within the U.S. yet discussions of trauma and violence against Native communities fail to consider the ongoing influence of settler colonialism. Too often trauma-focused work takes an individualist approach while policy work focuses on the collective, leading to a siloed approach in which micro-trauma work misses policy influences and in which policy work fails to seriously consider the ongoing trauma and violence experienced by Native Nations. Through the application of three Indigenous theoretical models that account for both historic and ongoing colonial influence, this work introduces relevant issues in the policy landscape of reproductive justice for Indigenous communities that are essential for trauma scholars and practitioners to understand.
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Affiliation(s)
- Autumn Asher BlackDeer
- Southern Cheyenne Nation, Graduate School of Social Work, University of Denver, Denver, Colorado, USA
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Kaufman CE, Asdigian NL, Reed ND, Shrestha U, Bull S, Begay RL, Shangreau C, Howley CT, Vossberg RL, Sarche M. A virtual randomized controlled trial of an alcohol-exposed pregnancy prevention mobile app with urban American Indian and Alaska Native young women: Native WYSE CHOICES rationale, design, and methods. Contemp Clin Trials 2023; 128:107167. [PMID: 37001855 PMCID: PMC10290431 DOI: 10.1016/j.cct.2023.107167] [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: 01/06/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorders (FASD) result in lifelong disability and are a leading cause of preventable birth defects in the US, including for American Indian and Alaska Natives (AIANs). Prevention of alcohol exposed pregnancies (AEPs), which can cause FASD, is typically aimed at adult women who are risky drinkers and have unprotected sex. Among AIANs, AEP prevention research has been primarily conducted in reservation communities, even though over 70% of AIANs live in urban areas. Culturally appropriate AEP prevention for urban AIAN young women, regardless of current drinking or sexual behaviors, may maximize the potential for primary prevention at the beginning of the reproductive years for this underserved population. METHODS We developed a virtual randomized controlled trial (RCT) - fully implemented through technology - to evaluate Native WYSE CHOICES, a culturally tailored mobile app, with urban AIAN young women ages 16-20 nationally. While virtual RCTs are not new, this is the first engaging a solely urban AIAN population, historically excluded from research. Participants are recruited on a rolling basis through the project social media community, organizational partnerships, and in-person events. Eligible participants complete a baseline survey and are randomized to either the app's intervention or comparison arm - each of which provide about 3 h of content. Follow-up data are collected at 1-, 6-, and 12-months post-baseline. RESULTS Our study offers a template for building trust and extending reach to this underserved population while also providing important lessons and insights on advances in virtual or hybrid research approaches.
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Affiliation(s)
- Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nancy L Asdigian
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Nicole D Reed
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Umit Shrestha
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Sheana Bull
- mHealth Impact Lab, Department of Community and Behavioral Health, Colorado School of Public Health, Mail Stop F802, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Rene L Begay
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Carly Shangreau
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Caitlin Trucksess Howley
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Raeann L Vossberg
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
| | - Michelle Sarche
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Mail Stop F800, 13055 East 17(th) Avenue, Aurora, CO 80045, United States of America.
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Arambula Solomon TG, Jones D, Laurila K, Ritchey J, Cordova-Marks FM, Hunter AU, Villanueva B. Using the Community Readiness Model to Assess American Indian Communities Readiness to Address Cancer Prevention and Control Programs. J Cancer Educ 2023; 38:206-214. [PMID: 34841496 PMCID: PMC9190249 DOI: 10.1007/s13187-021-02100-4] [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] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
Cancer disparities continue among American Indian and Alaska Native (AI/AN) populations while they have decreased among other racial and ethnic groups. No studies were found that utilized the Community Readiness Model (CRM) to ascertain the readiness of Tribal and American Indian organizations to participate in cancer research and cancer prevention and control initiatives. The Partnership for Native American Cancer Prevention conducted an assessment of the status of American Indian communities' readiness to implement activities for prevention, early detection, and treatment to improve AI/AN cancer rates. The assessment was a component of the Community Outreach Core of the grant. Thirty-four key Informants participated in the interview process. The Community Readiness Assessment (CRA) provided a baseline assessment of community partners' readiness to participate in cancer research and programming. Despite years of cancer intervention programs, the communities were classified as being in the early stages of readiness [1-5] of the nine-stage model. Additionally, findings showed low levels of awareness of previous or ongoing cancer research. The findings in prevention and control efforts indicated a need for technical assistance and funding to support community projects in prevention and control. This supported the implementation of a community grants initiative. They also indicated that communities were not ready to conduct research, despite ongoing cancer related research in at least two communities. Communication tools and social media methods and messages were developed to increase awareness of cancer as a health concern and cancer research in the community. The CRM informed these and other engagement activities to meet the appropriate stage of readiness for each Tribe/community, and to build their capacity to participate in cancer research and programming activities.
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Affiliation(s)
- Teshia G Arambula Solomon
- American Indian Research Center for Health, Dept. of Family & Community Medicine, University of Arizona, 1642 E. Helen, AZ, 85719, Tucson, USA.
- College of Medicine, University of Arizona, 1501 N. Campbell Avenue, AZ, 85724, Tucson, USA.
- Arizona Cancer Center, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ, 85724-5024, USA.
| | - Desiree Jones
- Arizona Cancer Center, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ, 85724-5024, USA
| | - Kelly Laurila
- Arizona Cancer Center, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ, 85724-5024, USA
- Northern Arizona University, 5 E. McConnell Drive, Flagstaff, AZ, 86011, USA
| | - Jamie Ritchey
- Inter-Tribal Council of Arizona, 2214 North Central Ave., Phoenix, AZ, 85004, USA
| | - Felina M Cordova-Marks
- American Indian Research Center for Health, Dept. of Family & Community Medicine, University of Arizona, 1642 E. Helen, AZ, 85719, Tucson, USA
- Arizona Cancer Center, University of Arizona, 1515 N. Campbell Ave, Tucson, AZ, 85724-5024, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ, 85724, USA
| | - Amanda Urbina Hunter
- American Indian Research Center for Health, Dept. of Family & Community Medicine, University of Arizona, 1642 E. Helen, AZ, 85719, Tucson, USA
- Northern Arizona University, 5 E. McConnell Drive, Flagstaff, AZ, 86011, USA
| | - Berna Villanueva
- American Indian Research Center for Health, Dept. of Family & Community Medicine, University of Arizona, 1642 E. Helen, AZ, 85719, Tucson, USA
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Stotz SA, Moore KR, McNulty M, Begay K, Scarton L, Jiang L, Adedoyin I, Brega AG. Evaluation of a Synchronous, Online Diabetes Nutrition Education Program for American Indians and Alaska Natives With Type 2 Diabetes: Facilitators and Participants' Experiences. J Nutr Educ Behav 2023; 55:114-124. [PMID: 36764793 DOI: 10.1016/j.jneb.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 10/03/2022] [Accepted: 10/31/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To explore the overall experiences of key players involved in a culturally adapted, online, synchronous diabetes nutrition education program across 5 reservation tribal and intertribal urban Indian clinics. METHODS A multimethods design, including postclass surveys with Likert-scale and short-answer questions, was completed after each of the 5 classes. Participants (n = 54) and class facilitators/coordinators (n = 10) completed postclass surveys (n = 189 and 58, respectively). A subset of participants (n = 24) and all class facilitators/coordinators (n = 10) engaged in online focus groups after the conclusion of program implementation. Qualitative thematic methods and frequency distributions were used to analyze the data. RESULTS Most participants reported that the classes were enjoyable (94%), culturally respectful (77%), and easily accessed online (68%). Qualitative themes included (1) class satisfaction, (2) class improvements, (3) preference for class facilitator, and (4) recommendations to improve recruitment and retention. CONCLUSIONS AND IMPLICATIONS These findings will guide program modifications to provide improved diabetes nutrition education for American Indians and Alaska Natives adults with type 2 diabetes.
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Affiliation(s)
- Sarah A Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Monica McNulty
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kelli Begay
- Maven Collective Consulting, Albuquerque, NM
| | - Lisa Scarton
- College of Nursing, University of Florida, Gainesville, FL
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA
| | | | - Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Stefanescu A, Jespersen M. American Indian/Alaska Native Birth and Maternal Health Outcomes in Louisiana: Investigating Regional Disparities. Matern Child Health J 2023; 27:318-327. [PMID: 36622538 DOI: 10.1007/s10995-022-03571-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report regional maternal and infant health characteristics in the Louisiana American Indian/Alaska Native (AIAN) population. METHODS This was a cross-sectional descriptive analysis using 2016-2019 Louisiana birth certificate data (N = 242,359; 3205 AIAN births). Prevalence of health characteristics and disparities from population averages were calculated. Health characteristics included low birth weight, preterm birth, very low birth weight, very preterm birth, high birth weight, NICU admission, breastfeeding at discharge, rurality, cesarean section, inadequate prenatal care, and maternal smoking. RESULTS Low birth weight prevalence ranged from 5.7% in central Louisiana to 20.7% in northeast Louisiana. Most other infant outcomes followed a similar pattern. Disparities from regional averages also varied. AIAN infants had 8% higher risk of LBW than the northeast Louisiana average and 4% lower risk in central Louisiana. Maternal smoking was most prevalent in northern and western Louisiana. Across Louisiana, maternal smoking was as or more prevalent in mothers of AIAN infants compared to regional averages. CONCLUSIONS FOR PRACTICE There is substantial regional variability in maternal and infant health characteristics in Louisiana AIAN populations, motivating emphasis on locally focused epidemiology to better serve Indigenous communities.
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Affiliation(s)
- Andrei Stefanescu
- Louisiana Department of Health, Office of Public Health, Bureau of Family Health, New Orleans, USA.
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
| | - Megan Jespersen
- Louisiana Department of Health, Infectious Disease Epidemiology, Baton Rouge, USA
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Quintana S, Ivanich JD, Pikok K, Nez S, Zepeda Z. Empowering American Indian and Alaska Native youth to lead measurement development of an indigenous adolescent wellbeing measure: A protocol paper. Front Public Health 2022; 10:994434. [PMID: 36466515 PMCID: PMC9715744 DOI: 10.3389/fpubh.2022.994434] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background American Indian and Alaska Native youth research has rarely included young people from within these populations as co-designers. In addition to the lack of youth involvement, most findings focus on presenting statistics around disparity vs. focusing on this population's unique strengths and resiliency. The research design of this protocol aims to fill this gap in the current literature. Methods To address this discrepancy, a multipronged approach to youth and young adult participatory research was implemented. These prongs included a virtual gathering where the Nominal Group Technique was conducted and an assembly of a Youth Research Design Team. Lastly, the research team will implement a protocol developed by the Research Design Team. The Research Design Team plans to conduct qualitative interviews and distribute a web-based quantitative survey with a raffle as respondent compensation. This protocol is a preliminary phase to developing a wellbeing measure for AIAN youth. Discussion Having an operationalized definition of wellness from AIAN youth will fill a gap in the current body of research with optimism that this will lead to additional studies exploring the AIAN youth voice.
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Affiliation(s)
- Sierra Quintana
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kimberly Pikok
- International Arctic Research Center, University of Fairbanks, Fairbanks, AL, United States
| | - Shanoa Nez
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tuscon, AZ, United States
| | - Zenetta Zepeda
- Biology Department, University of Colorado Denver, Denver, CO, United States
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14
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Markham CM, Rushing SC, Manthei J, Singer M, Jessen C, Gorman G, Peskin MF, Hernandez BF, Sacca L, Evans GS, Luna-Meza C, Merritt Z, Shegog R. The Healthy Native Youth Implementation Toolbox: Using Implementation Mapping to adapt an online decision support system to promote culturally-relevant sexual health education for American Indian and Alaska Native youth. Front Public Health 2022; 10:889924. [PMID: 36388328 PMCID: PMC9659648 DOI: 10.3389/fpubh.2022.889924] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023] Open
Abstract
Background American Indian and Alaska Native (AI/AN) youth experience serious disparities in sexual and reproductive health, including the highest teen birth rate among racial/ethnic groups, and disproportionate rates of sexually transmitted infections (STI), including HIV. A growing number of evidence-based programs (EBPs) that integrate the strengths and cultural teachings of Native communities exist. Yet, multiple factors, including lack of trained personnel, limited resources, and geographic isolation, may hinder their adoption and implementation. Innovative implementation strategies that facilitate the adoption and implementation of sexual health EBPs in Native communities may help reduce these disparities. Methods We applied Implementation Mapping, a systematic planning framework that utilizes theory, empirical evidence, and community input, to adapt a theory-based, online decision support system, iCHAMPSS (CHoosing And Maintaining Effective Programs for Sex Education in Schools), to support underlying dissemination and implementation processes unique to Native communities. We used an iterative design process, incorporating input from Native practitioners and academicians, to ensure that the adapted decision support system reflects cultural identification, community values, and experiences. Results Grounded in diffusion of innovations, organizational stage theory, and social cognitive theory, the Healthy Native Youth Implementation Toolbox supports Native practitioners through five phases (Gather, Choose, Prepare, Implement, and Grow) to adopt, implement, and maintain a culturally-relevant, age-appropriate sexual health EBP. The Toolbox provides tools, ready-to-use templates, and guidance to plan, implement, and grow a culturally-relevant adolescent health program with their Tribe or community. Hosted within the Healthy Native Youth website (www.healthynativeyouth.org), the Toolbox comprises: (1) a curriculum portal with access to 15 culturally-relevant, age-appropriate evidence-based health promotion programs for AI/AN youth; (2) a "resource library" comprising 20+ support tools, templates, and links to external resources, and (3) "stories from the field" comprising testimonials from experienced Native educators, who have implemented sexual health programs. Conclusion There is a continued need to design, test, and evaluate D&I strategies that are relevant to Native communities. The Healthy Native Youth Implementation Toolbox contributes to the dissemination and implementation of evidence-based, culturally-relevant sexual health education programs in diverse Native communities. Implementation Mapping provided a systematic approach to guide the adaptation process and integrate community voice with the ultimate goal of enhancing sexual health equity among AI/AN youth.
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Affiliation(s)
- Christine M. Markham
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | | | - Jane Manthei
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Cornelia Jessen
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Melissa F. Peskin
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Belinda F. Hernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, San Antonio, TX, United States
| | - Lea Sacca
- College of Medicine, Florida International University, Miami, FL, United States
| | - Gabrielle S. Evans
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Claudia Luna-Meza
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
| | - Zoe Merritt
- Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center Houston, Houston, TX, United States
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15
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Blacksher E, Trinidad SB, Woodbury RB, Hopkins SE, Woodahl EL, Boyer BB, Burke W, Hiratsuka V. Tribal Deliberations about Precision Medicine Research: Addressing Diversity and Inequity in Democratic Deliberation Design and Evaluation. J Empir Res Hum Res Ethics 2022; 17:304-316. [PMID: 35225705 PMCID: PMC9173705 DOI: 10.1177/15562646221081267] [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] [Indexed: 11/17/2022]
Abstract
Deliberative democratic engagement is used around the globe to gather informed public input on contentious collective questions. Yet, rarely has it been used to convene individuals exclusively from Indigenous communities. The relative novelty of using this approach to engage tribal communities and concerns about diversity and inequities raise important methodological questions. We describe the design and quality outcomes for a 2.5-day deliberation that elicited views of American Indian and Alaska Native (AIAN) leaders about the potential value and ethical conduct of precision medicine research (PMR), an emerging approach to research that investigates the health effects of individual genetic variation in tandem with variation in health-relevant practices, social determinants, and environmental exposures. The event met key goals, such as relationship and rapport formation, cross-site learning, equality of opportunity to participate, and respect among participants in the context of disagreement.
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16
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Whitesell NR, Howley CT, Asdigian NL, Clifford C, Senehi N. Community perspectives on developmental screening of American Indian and Alaska Native children. Infant Ment Health J 2022; 43:558-575. [PMID: 35634898 PMCID: PMC9283299 DOI: 10.1002/imhj.21992] [Citation(s) in RCA: 1] [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: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023]
Abstract
Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities.
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Affiliation(s)
- Nancy Rumbaugh Whitesell
- Tribal Early Childhood Research Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Caitlin Trucksess Howley
- Tribal Early Childhood Research Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Nancy L. Asdigian
- Tribal Early Childhood Research Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | | | - Neda Senehi
- Tribal Early Childhood Research Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - The Tribal Early Childhood Research Center PEDS Community of Learning
- The PEDS Community of Learning: Cyndi Anderson, Deana Around Him Wagner, Catherine Ayoub, Allison Barlow, Jessica Barnes-Najor, Moushumi Beltangady, Nicole Denmark, Cathy Ferron, Hiram Fitzgerald, Renee Galliher, Jacki Haight, Katie Hess, Elizabeth Kushman, KyungSook Lee, Charmaine Lundy, Laura McKechnie, Elizabeth Moore Simpson, Kim Nall, Douglas Novins, Myra Parker, Cyndi Pyatskowit, Melina Salvador, Juli Skinner, Sarah Snetsinger, Heather Tharp, Lana Toya, Melissa Walls
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17
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Trinidad SB, Blacksher E, Woodbury RB, Hopkins SE, Burke W, Woodahl EL, Boyer BB, Hiratsuka VY. Precision medicine research with American Indian and Alaska Native communities: Results of a deliberative engagement with tribal leaders. Genet Med 2022; 24:622-630. [PMID: 34906504 PMCID: PMC9754657 DOI: 10.1016/j.gim.2021.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/15/2021] [Revised: 09/15/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Amid calls for greater diversity in precision medicine research, the perspectives of Indigenous people have been underexplored. Our goals were to understand tribal leaders' views regarding the potential benefits and risks of such research, explore its priority for their communities, and identify the policies and safeguards they consider essential. This article reports on the participants' perspectives regarding governance and policy, stewardship and sharing of information and biospecimens, and informed consent. METHODS After informal local dialogs with 21 tribal leaders, we convened a 2.5-day deliberation with tribal leaders (N = 10) in Anchorage, Alaska, in June 2019 using a combination of small group and plenary discussion, ranking, and voting exercises to explore the perspectives on precision medicine research. RESULTS Tribal sovereignty was central to participants' ideas about precision medicine research. Although views were generally positive, provided that the appropriate controls were in place, some kinds of research were deemed unacceptable, and the collection of certain biospecimens was rejected by some participants. Differences were observed regarding the acceptability of broad consent. CONCLUSION Tribal leaders in this study were generally supportive of precision medicine research, with the caveat that tribal oversight is essential for the establishment of research repositories and the conduct of research involving Indigenous participants.
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Affiliation(s)
| | - Erika Blacksher
- Department of Bioethics and Humanities, UW School of Medicine, Seattle, WA
| | | | - Scarlett E Hopkins
- Department of Obstetrics and Gynecology and The Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR
| | - Wylie Burke
- Department of Bioethics and Humanities, UW School of Medicine, Seattle, WA
| | - Erica L Woodahl
- Department of Biomedical & Pharmaceutical Sciences, University of Montana, Missoula, MT
| | - Bert B Boyer
- Department of Obstetrics and Gynecology and The Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR
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18
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Hall NB, Nye MJ, Blackley DJ, Laney AS, Mazurek JM, Halldin CN. Respiratory health of American Indian and Alaska Native coal miners participating in the Coal Workers' Health Surveillance Program, 2014-2019. Am J Ind Med 2022; 65:162-165. [PMID: 35032040 PMCID: PMC10870733 DOI: 10.1002/ajim.23324] [Citation(s) in RCA: 1] [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: 09/22/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2014, a federal rule reduced occupational exposure limits to coal mine dust and expanded medical surveillance eligibility beyond underground miners to surface and contract coal miners. This expansion may have provided an opportunity for more American Indian and Alaska Native (AI/AN) coal miners to participate in screening, since many surface coal mines are located near AI/AN communities and may employ AI/AN miners. Therefore we sought to better understand the respiratory health of AI/AN coal miners by characterizing prevalence of coal workers' pneumoconiosis (CWP), progressive massive fibrosis (PMF), and abnormal lung function in this population. METHODS Descriptive analysis of 1405 chest radiographs and 627 spirometry test results for AI/AN miners who participated in the Coal Workers' Health Surveillance Program (CWHSP) during 2014-2019 was conducted. RESULTS Most AI/AN miners (0-25+ years of tenure) were western United States residents (82.3%) and active surface miners (76.9%) with no underground tenure. Among miners with at least 10 years of tenure, prevalence of CWP was 3.0%, and of PMF was 0.3%. Lung function abnormalities were seen in 9.0% with primarily restrictive patterns. CONCLUSIONS The prevalence of CWP, PMF, and lung function abnormality among active and former AI/AN coal miners was higher than seen in a larger CWHSP study of active western miners working primarily underground with 10+ years of tenure. Interventions that eliminate or control coal mine dust exposure, identify miners with CWP early, and limit respiratory disease progression and complications remain vital for eliminating the preventable adverse health effects of coal mining. Comprehensive demographic data on the coal mining workforce are needed to improve CWHSP participation assessment.
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Affiliation(s)
- Noemi B. Hall
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Maya J. Nye
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
- Association of Schools and Programs of Public Health (ASPPH)/Centers for Disease Control and Prevention (CDC) Public Health Fellow, Morgantown, West Virginia, USA
| | - David J. Blackley
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - A. Scott Laney
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Jacek M. Mazurek
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
| | - Cara N. Halldin
- Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA
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19
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Stotz SA, Hebert LE, Maddux A, Moore KR. Healthy Eating Determinants and Food Security Resource Opportunities: Urban-Dwelling American Indian and Alaska Native Older Adults Perspectives. J Nutr Educ Behav 2022; 54:186-193. [PMID: 34953642 PMCID: PMC8908730 DOI: 10.1016/j.jneb.2021.09.015] [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: 04/14/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the perspectives of urban-dwelling American Indian and Alaska Native (AI/AN) older adults regarding determinants of healthy eating, food insecurity, and opportunities for an urban clinic to improve resources. METHODS Semistructured interviews (n = 24) with older adults (aged ≥ 60 years) at 1 urban AI/AN serving clinic. Telephone-based interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis. RESULTS Four overarching themes were revealed: (1) hunger-mitigating resources exist but do not necessarily lessen food insecurity; (2) multiple layers of challenges related to social determinants of health present barriers to healthy nutrition for AI/AN older adults; (3) unique facilitators rooted in AI/AN culture can help decrease food insecurity; and (4) many clinic-based opportunities for programs to improve food insecurity exist. CONCLUSIONS AND IMPLICATIONS Findings provide a foundation for urban-serving AI/AN clinics to develop healthy eating resources for their older adult patients. Greater benefit would result from resources that build on cultural strengths and address older adult-specific challenges to healthy eating.
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Affiliation(s)
- Sarah A Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
| | | | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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20
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Allen J, Wexler L, Rasmus S. Protective Factors as a Unifying Framework for Strength-Based Intervention and Culturally Responsive American Indian and Alaska Native Suicide Prevention. Prev Sci 2022; 23:59-72. [PMID: 34169406 DOI: 10.1007/s11121-021-01265-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by contemporary prevention science. A promising development in AIAN suicide prevention highlights the role of protective factors. A protective factor framework adopts a social ecological perspective and community-level intervention paradigm. Emphasis on protection highlights strength-based AIAN cultural strategies in prevention of youth suicide. Attention to multiple intersecting levels incorporates strategies promoting community as well as individual resilience processes, seeking to influence larger contexts as well as individuals within them. This approach expands the scope of suicide prevention strategies beyond the individual level and tertiary prevention strategies. Interventions that focus on mechanisms of protection offer a rigorous, replicable, and complementary prevention science alternative to risk reduction approaches. This selected review critically examines recent AIAN protective factor suicide prevention science. One aim is to clarify key concepts including protection, resilience, and cultural continuity. A broader aim is to describe the evolution of this promising new framework for conducting primary research about AIAN suicide, and for designing and testing more effective intervention. Recommendations emphasize focus on mechanisms, multilevel interactions, more precise use of theory and terms, implications for new intervention development, alertness to unanticipated impacts, and culture as fundamental in a protective factors framework for AIAN suicide prevention. A protective factor framework holds significant potential for advancing AIAN suicide prevention and for work with other culturally distinct suicide disparity groups, with broad implications for other areas of prevention science.
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Affiliation(s)
- James Allen
- Department of Family Medicine and Biobehavioral Health and Memory Keepers Medical Discovery Team-American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, Duluth, MN, 55812, USA.
| | - Lisa Wexler
- Department of Social Work and Research Center for Group Dynamics, Institute for Social Research, Univeristy of Michigan, Ann Arbor, MI, 48104, USA
| | - Stacy Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, 99775, USA
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21
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Fort MP, Reid M, Russell J, Santos CJ, Running Bear U, Begay RL, Smith SL, Morrato EH, Manson SM. Diabetes Prevention and Care Capacity at Urban Indian Health Organizations. Front Public Health 2021; 9:740946. [PMID: 34900897 PMCID: PMC8661087 DOI: 10.3389/fpubh.2021.740946] [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] [Received: 07/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease. Urban Indian Health Organizations (UIHOs) are an important source of diabetes services for urban AI/AN people. Two evidence-based interventions-diabetes prevention (DP) and healthy heart (HH)-have been implemented and evaluated primarily in rural, reservation settings. This work examines the capacity, challenges and strengths of UIHOs in implementing diabetes programs. Methods: We applied an original survey, supplemented with publicly-available data, to assess eight organizational capacity domains, strengths and challenges of UIHOs with respect to diabetes prevention and care. We summarized and compared (Fisher's and Kruskal-Wallis exact tests) items in each organizational capacity domain for DP and HH implementers vs. non-implementers and conducted a thematic analysis of strengths and challenges. Results: Of the 33 UIHOs providing services in 2017, individuals from 30 sites (91% of UIHOs) replied to the survey. Eight UIHOs (27%) had participated in either DP (n = 6) or HH (n = 2). Implementers reported having more staff than non-implementers (117.0 vs. 53.5; p = 0.02). Implementers had larger budgets, ~$10 million of total revenue compared to $2.5 million for non-implementers (p = 0.01). UIHO strengths included: physical infrastructure, dedicated leadership and staff, and community relationships. Areas to strengthen included: staff training and retention, ensuring sufficient and consistent funding, and data infrastructure. Conclusions: Strengthening UIHOs across organizational capacity domains will be important for implementing evidence-based diabetes interventions, increasing their uptake, and sustaining these interventions for AI/AN people living in urban areas of the U.S.
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Affiliation(s)
- Meredith P Fort
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jenn Russell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cornelia J Santos
- Environmental Studies-Indigenous Sustainability Studies Program, Bemidji State University, Bemidji, MN, United States
| | - Ursula Running Bear
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Rene L Begay
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Savannah L Smith
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, United States
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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22
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Stotz S, Brega AG, Henderson JN, Lockhart S, Moore K. Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives. J Aging Health 2021; 33:31S-39S. [PMID: 34167350 PMCID: PMC8647808 DOI: 10.1177/08982643211013232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.
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Affiliation(s)
- Sarah Stotz
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela G. Brega
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J. Neil Henderson
- Memory Keepers Medical Discovery Team, Department of Family Medicine and Biobehavioral Health, The University of Minnesota Medical School, Duluth, MN, USA
| | - Steven Lockhart
- Children’s Hospital Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kelly Moore
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Soeters HM, Oliver SE, Plumb ID, Blain AE, Zulz T, Simons BC, Barnes M, Farley MM, Harrison LH, Lynfield R, Massay S, McLaughlin J, Muse AG, Petit S, Schaffner W, Thomas A, Torres S, Watt J, Pondo T, Whaley MJ, Hu F, Wang X, Briere EC, Bruce MG. Epidemiology of Invasive Haemophilus influenzae Serotype a Disease-United States, 2008-2017. Clin Infect Dis 2021; 73:e371-e379. [PMID: 32589699 PMCID: PMC9628811 DOI: 10.1093/cid/ciaa875] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Haemophilus influenzae serotype a (Hia) can cause invasive disease similar to serotype b; no Hia vaccine is available. We describe the epidemiology of invasive Hia disease in the United States overall and specifically in Alaska during 2008-2017. METHODS Active population- and laboratory-based surveillance for invasive Hia disease was conducted through Active Bacterial Core surveillance sites and from Alaska statewide invasive bacterial disease surveillance. Sterile-site isolates were serotyped via slide agglutination or real-time polymerase chain reaction. Incidences in cases per 100 000 were calculated. RESULTS From 2008 to 2017, an estimated average of 306 invasive Hia disease cases occurred annually in the United States (estimated annual incidence: 0.10); incidence increased by an average of 11.1% annually. Overall, 42.7% of cases were in children aged <5 years (incidence: 0.64), with highest incidence among children aged <1 year (1.60). Case fatality was 7.8% overall and was highest among adults aged ≥65 years (15.1%). Among children aged <5 years, the incidence was 17 times higher among American Indian and Alaska Native (AI/AN) children (8.29) than among children of all other races combined (0.49). In Alaska, incidences among all ages (0.68) and among children aged <1 year (24.73) were nearly 6 and 14 times higher, respectively, than corresponding US incidences. Case fatality in Alaska was 10.2%, and the vast majority (93.9%) of cases occurred among AI/AN. CONCLUSIONS Incidence of invasive Hia disease has increased since 2008, with the highest burden among AI/AN children. These data can inform prevention strategies, including Hia vaccine development.
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Affiliation(s)
- Heidi M. Soeters
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Sara E. Oliver
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ian D. Plumb
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Amy E. Blain
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Tammy Zulz
- Arctic Investigations Program, CDC, Anchorage, AK, USA
| | | | - Meghan Barnes
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Monica M. Farley
- Emory University School of Medicine and The Atlanta VA Medical Center, Atlanta, GA, USA
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford, CT, USA
| | | | - Ann Thomas
- Oregon Health Authority, Portland, OR, USA
| | | | - James Watt
- California Department of Public Health, Richmond, CA, USA
| | - Tracy Pondo
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Fang Hu
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Xin Wang
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Greenfield BL, Elm JHL, Hallgren KA. Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States. BMC Public Health 2021; 21:1099. [PMID: 34107882 PMCID: PMC8190861 DOI: 10.1186/s12889-021-11036-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city. METHODS Students (N = 347; 65% female; ages 18-65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined. RESULTS Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity. CONCLUSIONS In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.
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Affiliation(s)
- Brenna L Greenfield
- Department of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA.
| | - Jessica H L Elm
- Great Lakes Hub, Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, Washington, 98195, USA
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Stotz SA, Brega AG, Gonzales K, Hebert LE, Moore KR. Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives. Curr Dev Nutr 2021; 5:22-31. [PMID: 34222760 PMCID: PMC8242492 DOI: 10.1093/cdn/nzaa114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/14/2020] [Accepted: 07/02/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education. OBJECTIVE To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum. METHODS Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D (n = 29) and 4 focus groups were conducted with their family members (n = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process. RESULTS Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers. CONCLUSIONS Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.
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Affiliation(s)
- Sarah A Stotz
- The University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Angela G Brega
- The University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Kelly Gonzales
- Oregon Health Sciences University—Portland State University School of Public Health , Portland State University, Portland, OR, USA
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | - Kelly R Moore
- The University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
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Stotz SA, Charron-Prochownik D, Terry MA, Marshall G, Fischl AR, Moore KR. Stopping Gestational Diabetes in American Indian and Alaska Native Girls: Nutrition as a Key Component to Gestational Diabetes Risk Reduction. Curr Dev Nutr 2021; 5:13-21. [PMID: 34222764 PMCID: PMC8242493 DOI: 10.1093/cdn/nzaa081] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) women have a higher risk of gestational diabetes mellitus (GDM) and subsequent diagnosis of diabetes than do non-Hispanic White women. Healthy eating is key to weight management both prior to pregnancy and between pregnancies and can reduce the risk of developing GDM. Our research team developed an innovative preconception counseling and diabetes risk-reduction program, which includes nutrition and weight-management principles and is culturally tailored for adolescent AI/AN women. The program is entitled Stopping Gestational Diabetes Mellitus (SGDM). OBJECTIVE The purpose of this article is to examine nutrition-related information collected as a part of the formative qualitative research conducted for the development of a preconception counseling and gestational diabetes risk-reduction program, SGDM. METHODS This in-depth secondary analysis explored the original qualitative data from the needs assessment for SGDM program development. Participants included AI/AN women with a history of GDM (n = 5); AI/AN girls at risk of GDM (n = 14), and their mothers (n = 11), health care providers, and health administrators who care for AI/AN girls (n = 16); AI/AN elected leaders; and Indian health system administrators (n = 12). All focus groups and interviews were reanalyzed utilizing the following research question: "How do key stakeholders discuss food and/or nutrition in terms of gestational diabetes risk reduction for AI/AN adolescent girls?" RESULTS Three primary nutrition themes emerged: 1) AI/AN women were aware of healthy nutrition, healthy weight gainduring pregnancy, and healthy nutrition for people with type 2 diabetes, but these principles were not linked to reducing the risk of GDM; 2) participants expressed the need for education on the role of nutrition and weight management in GDM risk reduction; 3) participants shared challenges of healthful eating during and before pregnancy for AI/AN women. CONCLUSIONS These stakeholders' comments informed the development of the nutrition components of SGDM.
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Affiliation(s)
- Sarah A Stotz
- University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Denise Charron-Prochownik
- University of Pittsburgh, Nursing and Graduate School of Public Health, Department of Health Promotion and Development, Pittsburgh, PA, USA
| | - Martha A Terry
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Andrea R Fischl
- University of Pittsburgh, Nursing and Graduate School of Public Health, Department of Health Promotion and Development, Pittsburgh, PA, USA
| | - Kelly R Moore
- University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
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Collins N, Crowder J, Ishcomer-Aazami J, Apedjihoun D. Perceptions and Experiences of Frontline Urban Indian Organization Healthcare Workers With Infection Prevention and Control During the COVID-19 Pandemic. Front Sociol 2021; 6:611961. [PMID: 33996989 PMCID: PMC8119887 DOI: 10.3389/fsoc.2021.611961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/19/2021] [Indexed: 06/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's Project Firstline, NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.
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Affiliation(s)
- Noah Collins
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
| | - Jolie Crowder
- International Association for Indigenous Aging, Silver Spring, MD, United States
| | - Jamie Ishcomer-Aazami
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
| | - Dionne Apedjihoun
- National Council of Urban Indian Health, Technical Assistance and Research Center, Washington, DC, United States
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Allen J, Rasmus SM, Fok CCT, Charles B, Trimble J, Lee K. Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup'ik Alaska Native Youth Suicide. Assessment 2021; 28:709-723. [PMID: 31538813 PMCID: PMC8359856 DOI: 10.1177/1073191119875789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide is the second leading cause of death among American Indian and Alaska Native youth, and within the Alaska Native youth subpopulation, the leading cause of death. In response to this public health crisis, American Indian and Alaska Native communities have created strategies to protect their young people by building resilience using localized Indigenous well-being frameworks and cultural strengths. These approaches to suicide prevention emphasize promotion of protective factors over risk reduction. A measure of culturally based protective factors from suicide risk has potential to assess outcomes from these strengths-based, culturally grounded suicide prevention efforts, and can potentially address several substantive concerns regarding direct assessment of suicide risk. We report on the Reasons for Life (RFL) scale, a measure of protective factors from suicide, testing psychometric properties including internal structure with 302 rural Alaska Native Yup'ik youth. Confirmatory factor analyses revealed the RFL is best described through three distinct first-order factors organized under one higher second-order factor. Item response theory analyses identified 11 satisfactorily functioning items. The RFL correlates with other measures of more general protective factors. Implications of these findings are described, including generalizability to other American Indian and Alaska Native, other Indigenous, and other culturally distinct suicide disparities groups.
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Affiliation(s)
- James Allen
- University of Minnesota Medical School, Duluth, MN, USA
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Willging CE, Jaramillo ET, Haozous E, Sommerfeld DH, Verney SP. Macro- and meso-level contextual influences on health care inequities among American Indian elders. BMC Public Health 2021; 21:636. [PMID: 33794816 PMCID: PMC8013166 DOI: 10.1186/s12889-021-10616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/21/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND American Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government's federal trust responsibility to meet American Indians' health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level. METHODS Between June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders. RESULTS Findings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility. CONCLUSIONS Findings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility.
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Affiliation(s)
- Cathleen E. Willging
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Elise Trott Jaramillo
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - Emily Haozous
- Pacific Institute for Research and Evaluation, 851 University Blvd. SE, Suite 101, Albuquerque, NM 87106 USA
| | - David H. Sommerfeld
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA 92093-0812 USA
| | - Steven P. Verney
- Department of Psychology, University of New Mexico, MSC03-2220, Albuquerque, NM 87131-0001 USA
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Stotz S, Brega AG, Lockhart S, Hebert LE, Henderson JN, Roubideaux Y, Moore K. An online diabetes nutrition education programme for American Indian and Alaska Native adults with type 2 diabetes: perspectives from key stakeholders. Public Health Nutr 2021; 24:1449-1459. [PMID: 32677608 PMCID: PMC8132168 DOI: 10.1017/s1368980020001743] [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] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/10/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore stakeholder perspectives regarding online diabetes nutrition education for American Indians and Alaska Natives (AI/AN) with type 2 diabetes (T2D). DESIGN Qualitative data were collected through focus groups and interviews. Focus group participants completed a brief demographic and internet use survey. SETTING Focus groups and community participant interviews were conducted in diverse AI/AN communities. Interviews with nationally recognised content experts were held via teleconference. PARTICIPANTS Eight focus groups were conducted with AI/AN adults with T2D (n 29) and their family members (n 22). Community participant interviews were conducted with eleven clinicians and healthcare administrators working in Native communities. Interviews with nine content experts included clinicians and researchers serving AI/AN. RESULTS Qualitative content analysis used constant comparative method for coding and generating themes across transcripts. Descriptive statistics were computed from surveys. AI/AN adults access the internet primarily through smartphones, use the internet for many purposes and identify opportunities for online diabetes nutrition education. CONCLUSIONS Online diabetes nutrition education may be feasible in Indian Country. These findings will inform the development of an eLearning diabetes nutrition education programme for AI/AN adults with T2D.
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Affiliation(s)
- Sarah Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luciana E Hebert
- Elson S. Floyd College of Medicine, Institute for Research and Education Advancing Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - J Neil Henderson
- Department of Family Medicine and Biobehavioral Health, The University of Minnesota Medical School, Duluth, MN, USA
| | | | - Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Nadeau KJ, Stotz SA, Moore K, Garcia-Reyes Y, Sereika SM, Stein H, Charron-Prochownik D. Beta Testing of a Gestational Diabetes Risk Reduction Intervention for American Indian and Alaska Native Teens. J Pediatr Health Care 2020; 34:418-423. [PMID: 32532483 PMCID: PMC7608544 DOI: 10.1016/j.pedhc.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION American Indian and Alaska Native (AIAN) girls have double the risk of obesity, pregnancy, and gestational diabetes mellitus (GDM) than the general U.S. POPULATION The purpose of this study was to beta test Stopping GDM (SGDM), a GDM risk reduction intervention for at-risk AIAN teens, before beginning a randomized controlled trial. METHOD A sample of 11 AIAN mothers and daughters were recruited through an urban Indian health program. Daughters were at risk of GDM as assessed by a BMI ≥ 85th percentile. Pre- and posttest online questionnaires evaluated the online intervention (e-book and video). RESULTS Mean pre- to posttest knowledge increased for mothers and daughters on diabetes prevention, reproductive health, and GDM knowledge. Daughters demonstrated an increased self-efficacy for healthy living and pregnancy planning. Satisfaction for the e-book, video, and online survey was moderately high to very high. DISCUSSION The SGDM intervention is feasible and acceptable in AIAN mother-daughter dyads. These findings informed the SGDM intervention and the randomized controlled trial evaluation protocol.
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Hatcher SM, Joshi S, Robinson BF, Weiser T. Hepatitis C-Related Mortality Among American Indian/Alaska Native Persons in the Northwestern United States, 2006-2012. Public Health Rep 2020; 135:66-73. [PMID: 31765285 PMCID: PMC7119253 DOI: 10.1177/0033354919887748] [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: 12/09/2022] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AI/AN) persons are commonly misclassified in epidemiologic and administrative data sets. The race-corrected hepatitis C virus (HCV)-related mortality rate among AI/AN persons in the Northwest United States (Idaho, Oregon, and Washington State) is unknown. We quantified the disparity in HCV-related mortality between AI/AN persons and non-Hispanic white (NHW) persons in the Northwest during 2006-2012 after correcting misclassified AI/AN race. METHODS After conducting probabilistic record linkage between death records and the Northwest Tribal Registry, we calculated HCV-related mortality rates for AI/AN and NHW persons by using National Center for Health Statistics bridged-race estimates standardized to the US 2000 standard population. RESULTS The 2006-2012 aggregate age-adjusted HCV-related mortality rate per 100 000 population in the Northwest was 19.6 (95% confidence interval [CI], 17.3-22.2) for AI/AN persons and 5.9 (95% CI, 5.7-6.1) for NHW persons (rate ratio [RR] = 3.3; 95% CI, 3.0-3.8). The disparity was larger among females (RR = 4.6; 95% CI, 3.8-5.5) than among males (RR = 2.9; 95% CI, 2.5-3.4). CONCLUSION The disproportionate rate of HCV-related mortality among AI/AN persons in the Northwest highlights the need to expand HCV education, screening, and treatment among this population.
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Affiliation(s)
- Sarah M. Hatcher
- Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
| | - Sujata Joshi
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
| | - Byron F. Robinson
- Epidemic Intelligence Service, Epidemiology Workforce Branch, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Weiser
- Northwest Portland Area Indian Health Board, Northwest Tribal Epidemiology Center, Portland, OR, USA
- Portland Area Indian Health Service, Portland, OR, USA
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Abstract
American Indian and Alaska Native women had approximately twice the incidence of cervical cancer as white women. Preventive measures for cervical cancer rely on screening and HPV vaccination. However, vaccine series completion and catch-up vaccinations for eligible adults are low across all racial/ethnic groups. Therefore, the aim of this study was to identify gaps in knowledge and evaluate the attitudes toward HPV and the vaccine among AIANs with various levels of training in the STEM and health-related fields. A survey was used to collect data from audience members at two national conferences geared towards American Indian and Alaska Natives in health and STEM fields in September 2017. A vignette study was administered via a live electronic poll to test knowledge (true/false questions), attitudes, and to collect demographic information. Respondents self-identified as primarily American Indian and Alaska Native (74%), pursuing or completed a graduate degree (67%), and female (85%). Most respondents (86%) were aware of HPV-associated cancer in men. However, most (48-90%) answered incorrectly to detailed true/false statements about HPV and available vaccines. After educational information was provided, opinions collected via vignettes highlighted mainly positive attitudes toward vaccination; specifically, that vaccines are safe and all eligible community members should be vaccinated (75% and 84%, respectively). We observed that our respondents with higher educational attainment still lacked accurate knowledge pertaining to HPV and the vaccine. Overall, continued education about HPV and the vaccine is needed across all levels of education including American Indian and Alaska Native community members and health professionals.
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Affiliation(s)
- Naomi R Lee
- Department of Molecular Genetics and Microbiology, University of New Mexico, Albuquerque, NM, USA. Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Carolyn J Noonan
- Partnerships for Native Health, Initiative for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
| | - Lonnie Nelson
- Partnerships for Native Health, Initiative for Research and Education to Advance Community Health, College of Nursing, Washington State University, Seattle, WA, USA
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD, USA. Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
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Rasmus SM, Charles B, John S, Allen J. With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska. Am J Community Psychol 2019; 64:34-45. [PMID: 31343758 PMCID: PMC6750997 DOI: 10.1002/ajcp.12356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 05/23/2023]
Abstract
This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.
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Affiliation(s)
- Stacy M. Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Simeon John
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN 55805
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Garcia AN, Castro MC, Sánchez JP. Social and Structural Determinants of Urban American Indian and Alaska Native Health: A Case Study in Los Angeles. MedEdPORTAL 2019; 15:10825. [PMID: 31161137 PMCID: PMC6543927 DOI: 10.15766/mep_2374-8265.10825] [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] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/08/2019] [Indexed: 05/14/2023]
Abstract
Introduction American Indians and Alaska Natives (AIAN) experience significant health inequities, yet there are very few curricula dedicated to training a culturally sensitive workforce to care for this population. There is a further dearth of curricula that center on Indigenous values and ways of knowing. Methods We developed a 90-minute interactive workshop aimed at increasing faculty and trainee understanding of the social and structural determinants of urban AIAN health. The workshop consisted of a PowerPoint presentation, two videos, an interactive storytelling exercise, and reflection exercises. Participants also completed pre-/postworkshop questionnaires. The workshop was implemented three times at two medical schools. Results There were a total of 35 diverse participants. Regarding the effect of the workshop on participants' knowledge base, a comparison of pre- and postworkshop questionnaire responses showed a statistically significant (p < .05) increase in the correct answer being chosen for each question. All participants agreed or strongly agreed that each of the three learning objectives had been met. Participants particularly valued the workshop's interactive nature, as well as its use of storytelling and multimedia to reinforce policy impact. Discussion This workshop provided an interactive and effective method to increase participant knowledge of the importance of a land acknowledgment, of connecting federal Indian policy to health outcomes, and of how AIAN identity may impact access to health care.
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Affiliation(s)
- Andrea N. Garcia
- Visiting Project Scientist, Center for Health Services and Society, Department of Psychiatry, UCLA David Geffen School of Medicine
- Physician Specialist, Los Angeles County Department of Mental Health
- Board Member, BNGAP, Inc
| | - Monique C. Castro
- Owner, Indigenous Circle of Wellness
- Founder, Indigenous Circle of Wellness
| | - John Paul Sánchez
- Associate Professor, Emergency Medicine, Rutgers New Jersey Medical School
- Associate Dean, Diversity and Inclusion, Rutgers New Jersey Medical School
- Founder, BNGAP, Inc
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Craig Rushing S, Stephens D, Shegog R, Torres J, Gorman G, Jessen C, Gaston A, Williamson J, Tingey L, Lee C, Apostolou A, Kaufman C, Markham CM. Healthy Native Youth: Improving Access to Effective, Culturally-Relevant Sexual Health Curricula. Front Public Health 2018; 6:225. [PMID: 30175091 PMCID: PMC6107849 DOI: 10.3389/fpubh.2018.00225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/13/2022] Open
Abstract
Tribal health educators across the United States have found it challenging to locate engaging, culturally-relevant sexual health curricula for American Indian and Alaska Native (AI/AN) youth. Healthy Native Youth is a new online resource that provides a "one-stop-shop" for tribal health advocates to access age-appropriate curricula. The site was designed by a team of advisers representing a diverse group of tribal communities, using a collaborative planning process. The website content and navigation was then refined through usability testing with the target audience. The portal allows users to filter and compare curricula on multiple dimensions, including: age, delivery setting, duration, cost, and evidence of effectiveness, to determine best-fit. It includes all materials needed for implementation free-of-charge, including: facilitator training tools, lesson plans, materials to support participant marketing and recruitment, information about each program's cultural relevance, evaluation methods and findings, and references to publications and reports. The website currently includes mCircle of Life, Native It's Your Game, Native STAND, Native VOICES, and Safe in the Village, among others. Since its launch in August 2016, the site has had over 31,000 page views in all 50 States. The Healthy Native Youth portal provides educators in rural communities a promising new tool to support the dissemination and implementation of evidence-based health curricula in geographically-disbursed AI/AN communities. Lessons learned during the design and dissemination of the Healthy Native Youth website may be of value to other Indigenous populations interested in our approach and our findings.
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Affiliation(s)
| | - David Stephens
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Ross Shegog
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Torres
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gwenda Gorman
- Inter Tribal Council of Arizona, Inc., Phoenix, AZ, United States
| | - Cornelia Jessen
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Amanda Gaston
- Northwest Portland Area Indian Health Board, Portland, OR, United States
| | - Jennifer Williamson
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, United States
| | - Lauren Tingey
- Johns Hopkins Center for American Indian Health, Baltimore, MD, United States
| | - Crystal Lee
- UCLA David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, Global Center for Children and Families, Los Angeles, CA, United States
| | - Andria Apostolou
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, MD, United States
| | - Carol Kaufman
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, United States
| | - Christine Margaret Markham
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Hiratsuka VY, Parker ME, Sanchez J, Riley R, Heath D, Chomo JC, Beltangady M, Sarche M. CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES. Infant Ment Health J 2018; 39:265-275. [PMID: 29767424 DOI: 10.1002/imhj.21708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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] [Indexed: 11/07/2022]
Abstract
The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.
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Affiliation(s)
| | | | - Jenae Sanchez
- Pueblo of San Felipe Health and Wellness Department, Algodones, New Mexico
| | - Rebecca Riley
- Native American Professional Parent Resources, Albuquerque, New Mexico
| | | | | | - Moushumi Beltangady
- U.S. Department of Health & Human Services, Administration for Children and Families
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Whitmore CB, Sarche M, Ferron C, Moritsugu J, Sanchez JG. LESSONS LEARNED AND NEXT STEPS FOR BUILDING KNOWLEDGE ABOUT TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING. Infant Ment Health J 2018; 39:358-365. [PMID: 29767439 DOI: 10.1002/imhj.21707] [Citation(s) in RCA: 2] [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] [Indexed: 11/11/2022]
Abstract
Authors in this Special Issue of the Infant Mental Health Journal shared the work of the first three cohorts of Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees funded by the Administration for Children and Families. Since 2010, Tribal MIECHV grantees have served families and children prenatally to kindergarten entry in American Indian and Alaska Native (AI/AN) communities across the lower 48 United States and Alaska. Articles highlighted challenges and opportunities that arose as grantees adapted, enhanced, implemented, and evaluated their home-visiting models. This article summarizes nine lessons learned across the articles in this Special Issue. Lessons learned address the importance of strengths-based approaches, relationship-building, tribal community stakeholder involvement, capacity-building, alignment of resources and expectations, tribal values, adaptation to increase cultural and contextual attunement, indigenous ways of knowing, community voice, and sustainability. Next steps in Tribal MIECHV are discussed in light of these lessons learned.
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Affiliation(s)
| | | | - Cathy Ferron
- Lake County Tribal Health Consortium Home Visiting Program and Ferron & Associates Evaluation Consultants, San Rafael, California
| | - John Moritsugu
- South Puget Intertribal Planning Agency, Shelton, Washington
| | - Jenae G Sanchez
- Project KEVA Tribal Home Visiting Program, San Felipe Pueblo, New Mexico
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Asdigian NL, Bear UR, Beals J, Manson SM, Kaufman CE. Mental health burden in a national sample of American Indian and Alaska Native adults: differences between multiple-race and single-race subgroups. Soc Psychiatry Psychiatr Epidemiol 2018; 53:521-530. [PMID: 29470596 DOI: 10.1007/s00127-018-1494-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Research on American Indian and Alaska Native (AIAN) mental health disparities is based largely on either tribal populations or national samples of adults that do not account for multiracial AIANs, even though over 40% of AIANs identify with multiple racial groups. The present investigation extends this research by assessing mental health status in a national sample of multiracial AIAN adults relative to adults who identify exclusively as either AIAN or White. METHODS 2012 BRFSS data were used to conduct multinomial logistic regression analyses comparing mental health outcomes among respondents who identified as either AIAN and one or more other races (AIAN-MR), AIAN-Single Race (AIAN-SR), or White-SR. RESULTS After demographic adjustment, the AIAN-MR group reported a higher lifetime prevalence of diagnosed depressive disorder, more days of poor mental health, and more frequent mental distress compared to both the AIAN-SR and White-SR groups. AIAN-MR individuals also had higher levels of Kessler 6 (K6) non-specific psychological distress compared to White-SR individuals but not AIAN-SR adults. Differences between AIAN-SR and White-SR adults were found in days of poor mental health, frequent mental distress, and total K6 scores. CONCLUSIONS These findings help gauge the magnitude of mental health disparities in the U.S. AIAN population and pinpoint AIAN subgroups for whom mental health is particularly problematic. As such, they raise concerns about restrictions that limit the identification of national survey respondents who report multiple race designations. Such restrictions will thwart efforts to understand the causal mechanisms and pathways leading to mental distress among AIAN individuals.
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Affiliation(s)
- Nancy L Asdigian
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA.
| | - Ursula Running Bear
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Janette Beals
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Spero M Manson
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
| | - Carol E Kaufman
- Department of Community and Behavioral Health,Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, Aurora, CO, 80045, USA
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Novins D, Meyer A, Beltangady M. CONTEXTUAL ISSUES FOR IMPLEMENTATION AND EVALUATION OF HOME-VISITATION PROGRAMS FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES: AN INTRODUCTION TO THE TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM. Infant Ment Health J 2018; 39:259-264. [PMID: 29742290 DOI: 10.1002/imhj.21705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 12/17/2022]
Abstract
Home-visiting programs have become a key component of evidence-based services for pregnant women, new mothers, their infants, and their families. When Congress authorized the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) in 2010, it set aside 3% of the $1.5 billion in funding to support home-visiting programs operated by tribes, Tribal MIECHV programs have been funded in 14 states and have served over 3,100 families, providing nearly 55,000 home visits to families at risk for poor child, maternal, and family outcomes. In this Introduction to the Special Issue of the Infant Mental Health Journal on the Tribal MIECHV initiative, we provide some key contexts of the work of the Tribal MIECHV grantees as well as an overview of the issues covered in the other articles.
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Affiliation(s)
| | - Aleta Meyer
- U.S. Department of Health & Human Services, Administration for Children and Families
| | - Moushumi Beltangady
- U.S. Department of Health & Human Services, Administration for Children and Families
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Harfield SG, Davy C, McArthur A, Munn Z, Brown A, Brown N. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Global Health 2018; 14:12. [PMID: 29368657 PMCID: PMC5784701 DOI: 10.1186/s12992-018-0332-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 10/08/2017] [Accepted: 01/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. Method This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Results Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. Conclusion While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models. Electronic supplementary material The online version of this article (10.1186/s12992-018-0332-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen G Harfield
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. .,School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia. .,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
| | - Carol Davy
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alexa McArthur
- Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zachary Munn
- Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Ngiare Brown
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Education and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Cunningham JK, Solomon TA, Muramoto ML. Alcohol use among Native Americans compared to whites: Examining the veracity of the 'Native American elevated alcohol consumption' belief. Drug Alcohol Depend 2016; 160:65-75. [PMID: 26868862 DOI: 10.1016/j.drugalcdep.2015.12.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [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] [Received: 05/10/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study uses national survey data to examine the veracity of the longstanding belief that, compared to whites, Native Americans (NA) have elevated alcohol consumption. METHODS The primary data source was the National Survey on Drug Use and Health (NSDUH) from 2009 to 2013: whites (n=171,858) and NA (n=4,201). Analyses using logistic regression with demographic covariate adjustment were conducted to assess differences in the odds of NA and whites being alcohol abstinent, light/moderate drinkers (no binge/heavy consumption), binge drinkers (5+ drinks on an occasion 1-4 days), or heavy drinkers (5+ drinks on an occasion 5+ days) in the past month. Complementary alcohol abstinence, light/moderate drinking and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 to 2013: whites (n=1,130,658) and NA (n=21,589). RESULTS In the NSDUH analyses, the majority of NA, 59.9% (95% CI: 56.7-63.1), abstained, whereas a minority of whites, 43.1% (CI: 42.6-43.6), abstained-adjusted odds ratio (AOR): 0.64 (CI: 0.56-0.73). Approximately 14.5% (CI: 12.0-17.4) of NA were light/moderate-only drinkers, versus 32.7% (CI: 32.2-33.2) of whites (AOR: 1.90; CI: 1.51-2.39). NA and white binge drinking estimates were similar-17.3% (CI: 15.0-19.8) and 16.7% (CI: 16.4-17.0), respectively (AOR: 1.00; CI: 0.83-1.20). The two populations' heavy drinking estimates were also similar-8.3% (CI: 6.7-10.2) and 7.5% (CI: 7.3-7.7), respectively (AOR: 1.06; CI: 0.85-1.32). Results from the BRFSS analyses generally corroborated those from NSDUH. CONCLUSIONS In contrast to the 'Native American elevated alcohol consumption' belief, Native Americans compared to whites had lower or comparable rates across the range of alcohol measures examined.
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Affiliation(s)
- James K Cunningham
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States; Native American Research and Training Center, The University of Arizona, 1642 East Helen Street, Tucson, AZ 85719, United States.
| | - Teshia A Solomon
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States; Native American Research and Training Center, The University of Arizona, 1642 East Helen Street, Tucson, AZ 85719, United States.
| | - Myra L Muramoto
- Department of Family and Community Medicine, The University of Arizona, 1450 N. Cherry Avenue, Tucson, AZ 85719, United States.
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