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Hoffman KA, Graves C, Rowe K, Worth J, Pertl K, Laidler J, Korthuis P, McCarty D. Engaging the Great Circle: a qualitative study of the Confederated Tribes of Grand Ronde’s mobile medication unit. Ann Med 2024; 56:2306492. [PMID: 38271558 PMCID: PMC10812851 DOI: 10.1080/07853890.2024.2306492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The Confederated Tribes of the Grand Ronde Community of Oregon began a Mobile Medication Unit (MMU) as part of their Great Circle Recovery Opioid Treatment Program (OTP) to address elevated rates of opioid use disorder (OUD) among American Indians and Alaska Natives in Oregon. The MMU provides methadone or buprenorphine for individuals with OUD, enrolled in the OTP, who are living either on the reservation or in surrounding rural communities. An implementation study describes the service through document review and qualitatively assesses patient and staff experiences and the perceived barriers and facilitators to mobile services. METHODS Semi-structured qualitative interviews with patients (n = 11), MMU staff (n = 5), and the state opioid treatment authority (n = 1) gathered details on the initiative's development and operations. Provider interviews probed implementation experiences. Patient interviews focused on their experiences with the MMU and staff, changes in quality of life and recommendations for enhancing treatment. Interviews were transcribed and analysed using a Thematic Analysis approach. RESULTS Staff themes identified two driving forces (i.e. staff desire for an inclusive approach to wellness that is accessible to all community members; the catalysts for the MMU), two steps toward MMU development (i.e. Tribal approvals and support; the construction and maintenance of community relationships) and two perspectives on MMU implementation and impact (i.e. initial implementation barriers; facilitators and observations of how the MMU reduced stigma associated with agonist therapy). Patients' themes noted the MMU's professional and 'caring' environment, accessible rural locations and general suggestions including culturally responsive ancillary services. CONCLUSION The Great Circle MMU enhanced access to opioid agonist therapy for people with OUD (i.e. American Indians/Alaska Natives, and non-natives) living in rural communities. The Confederated Tribes of Grand Ronde operates the first Tribally owned OTP MMU, grounded in cultural humility and committed to Tribal members and the great circle of the larger community.
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Affiliation(s)
- Kim A. Hoffman
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Chantell Graves
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kelly Rowe
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Jennifer Worth
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - Kellie Pertl
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - James Laidler
- Grand Ronde Great Circle Opioid Treatment Program, Grand Ronde Oregon, OR, USA
| | - P. Todd Korthuis
- Department of Medicine, OR Health and Science University, Portland, OR, USA
| | - Dennis McCarty
- Department of Medicine, OR Health and Science University, Portland, OR, USA
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Campbell JE, Chen S, Bailey A, Blair A, Comiford AL. Investigating Cannabis-Use Among Students Attending High Schools Within the Cherokee Nation Reservation 2017 and 2019. J Community Health 2024; 49:402-414. [PMID: 38066219 PMCID: PMC10981585 DOI: 10.1007/s10900-023-01304-7] [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: 10/25/2023] [Indexed: 02/18/2024]
Abstract
Oklahoma's medical cannabis is some of the least restrictive in the US. Previous research suggests that American Indian/Alaska Native (AIAN) have higher rates of cannabis use than other racial or ethnic groups. The goals of this paper are, first, to look at cannabis use among high school students living on the Cherokee Nation Reservation before (2017) and after (2019) medical cannabis because legal in Oklahoma (2018) utilizing the Cherokee Nation Youth Risk Behavior Survey (CNYRBS). Second, to describe the socio-demographic characteristics of youth using cannabis in the Cherokee Nation Reservation. Data were retrieved from the 2017 and 2019 CNYRBS. The data for this study included 1,216 high school students who completed the 2017 and 1,476 who completed the 2019 CNYRBS. After removal of incomplete records, there were 2,602 students whose data was analyzed in this study. Data were weighted to be representative of public-school students attending grades 9-12 within Cherokee Nation Reservation. Despite the legalization of medical cannabis in Oklahoma in 2018, there was no change in cannabis use among youth between 2017 and 2019. There were variations in cannabis use based on demographic factors and other substance uses. AIAN individuals had higher odds of current cannabis use compared to non-Hispanic White students, but there were no differences based on ethnicity. Additionally, the use of cigarettes, e-cigarettes, alcohol, and illegal drugs were associated with increased odds of cannabis use among both current and former users compared to those who had never used it. There was no spike in use among youth at least immediately after the legalization of cannabis in the Cherokee Nation Reservation. There were socio-demographic as well as substance use disparities in the use of cannabis.
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Affiliation(s)
- Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Anna Bailey
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Andrea Blair
- Cherokee Nation Public Health, 1325 East Boone Street, Tahlequah, OK, 74464, USA
| | - Ashley L Comiford
- Cherokee Nation Health Services, 19600 East Ross Road, Tahlequah, OK, 74464, USA
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Price JH, Khubchandani J. Fatal Firearm Violence Among American Indians and Alaska Natives. J Community Health 2024; 49:492-498. [PMID: 38127297 DOI: 10.1007/s10900-023-01300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
There is a dearth of population-based studies regarding firearm-related deaths and years of potential life lost among American Indians and Alaska Natives (AI/AN). Using the Centers for Disease Control and Prevention's (CDC) We Based Injury Statistics Query and Reporting System (WISQARS) data for the three most recent years (2018-2020), we analyzed the demographic characteristics of AI/ANs who succumbed to firearm violence. AI/ANs averaged almost 500 firearm-related deaths per year. The majority of these deaths were observed among individuals 20-39 years of age (53%), males (84.4%), and in the West (55.3%). A plurality of these firearm-related deaths were suicides (48.9%) followed by homicides (43.5%). During the 3-year study period, the age-adjusted firearm death rate increased almost 5 times the growth of the AI/AN population. Also, a staggering 67,050 years of potential life were lost before the age of 80 years (YPLL80) during this period. Firearm suicides were responsible for the largest proportion of YPLL80s (48.5%). Traditional legal interventions [e.g., child access prevention (CAP) laws and extreme risk protection orders (ERPO)], if expanded to more states could potentially help reduce AI/AN firearm mortality. None of the 10 states with the highest firearm mortality of AI/AN have ERPOs and 8 of the 10 do not have CAP laws. Also, a renewed focus on cultural continuity and indigenous protective factors is essential to ameliorate the level of firearm violence in AI/ANs.
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Tanne JH. Deaths of despair are higher among black and Native Americans, study finds. BMJ 2024; 385:q863. [PMID: 38621811 DOI: 10.1136/bmj.q863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
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Kelley BS, Walker MR, Hampton JM, Zafar SN, Carroll CB, Hayden D, Schiefelbein A, Thompson BB, LoConte NK. HSR24-127: Rectal Cancer Disparities in Age and Overall Survival Among American Indian and Alaska Native Vs Non-Hispanic White Populations. J Natl Compr Canc Netw 2024; 22:HSR24-127. [PMID: 38579795 DOI: 10.6004/jnccn.2023.7196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Broc S Kelley
- 1University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Margaret R Walker
- 1University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John M Hampton
- 2University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Syed Nabeel Zafar
- 1University of Wisconsin School of Medicine and Public Health, Madison, WI
- 2University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Dana Hayden
- 1University of Wisconsin School of Medicine and Public Health, Madison, WI
- 2University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Noelle K LoConte
- 1University of Wisconsin School of Medicine and Public Health, Madison, WI
- 2University of Wisconsin Carbone Cancer Center, Madison, WI
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Lowe J, Brooks J, Lawrence G, Baldwin JA, Kelley M, Wimbish-Tompkins R. Intertribal Talking Circle for the prevention of alcohol and drug use among Native American youth. Res Nurs Health 2024; 47:234-241. [PMID: 38281085 DOI: 10.1002/nur.22372] [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: 06/10/2023] [Revised: 11/06/2023] [Accepted: 12/24/2023] [Indexed: 01/29/2024]
Abstract
The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community-based participatory research was used to implement a two-condition, quasi-experimental study. The sample included 540 Native American youth ages 10-12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12-months post-intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10-12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth.
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Affiliation(s)
- John Lowe
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Jada Brooks
- UNC School of Nursing, Chapel Hill, North Carolina, USA
| | - Gary Lawrence
- Choctaw Nation Health Services Authority, One Choctaw Way, Talihina, Oklahoma, USA
| | - Julie A Baldwin
- Department of Health Sciences, Center for Health Equity Research (CHER), Northern Arizona University, Flagstaff, Arizona, USA
| | - Melessa Kelley
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Rose Wimbish-Tompkins
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
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Slowly M, Domingo-Relloso A, Santella RM, Haack K, Fallin DM, Terry MB, Rhoades DA, Herreros-Martinez M, Garcia-Esquinas E, Cole SA, Tellez-Plaza M, Navas-Acien A, Wu HC. Blood DNA methylation and liver cancer in American Indians: evidence from the Strong Heart Study. Cancer Causes Control 2024; 35:661-669. [PMID: 38010586 PMCID: PMC10960679 DOI: 10.1007/s10552-023-01822-8] [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: 04/29/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Liver cancer incidence among American Indians/Alaska Natives has risen over the past 20 years. Peripheral blood DNA methylation may be associated with liver cancer and could be used as a biomarker for cancer risk. We evaluated the association of blood DNA methylation with risk of liver cancer. METHODS We conducted a prospective cohort study in 2324 American Indians, between age 45 and 75 years, from Arizona, Oklahoma, North Dakota and South Dakota who participated in the Strong Heart Study between 1989 and 1991. Liver cancer deaths (n = 21) were ascertained using death certificates obtained through 2017. The mean follow-up duration (SD) for non-cases was 25.1 (5.6) years and for cases, 11.0 (8.8) years. DNA methylation was assessed from blood samples collected at baseline using MethylationEPIC BeadChip 850 K arrays. We used Cox regression models adjusted for age, sex, center, body mass index, low-density lipoprotein cholesterol, smoking, alcohol consumption, and immune cell proportions to examine the associations. RESULTS We identified 9 CpG sites associated with liver cancer. cg16057201 annotated to MRFAP1) was hypermethylated among cases vs. non-cases (hazard ratio (HR) for one standard deviation increase in methylation was 1.25 (95% CI 1.14, 1.37). The other eight CpGs were hypomethylated and the corresponding HRs (95% CI) ranged from 0.58 (0.44, 0.75) for cg04967787 (annotated to PPRC1) to 0.77 (0.67, 0.88) for cg08550308. We also assessed 7 differentially methylated CpG sites associated with liver cancer in previous studies. The adjusted HR for cg15079934 (annotated to LPS1) was 1.93 (95% CI 1.10, 3.39). CONCLUSIONS Blood DNA methylation may be associated with liver cancer mortality and may be altered during the development of liver cancer.
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Affiliation(s)
- Monique Slowly
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - Regina M Santella
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Karin Haack
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Daniele M Fallin
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dorothy A Rhoades
- Department of Medicine, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | | | - Esther Garcia-Esquinas
- Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Shelley A Cole
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Maria Tellez-Plaza
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Hui-Chen Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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Martinez SA, Anderson AS, Burkhart M, Gopalani SV, Janitz AE, Campbell JE, White AH, Comiford AL. Perception of Barriers to and Factors Associated with HPV Vaccination Among Parents of American Indian Adolescents in the Cherokee Nation. J Racial Ethn Health Disparities 2024; 11:958-967. [PMID: 36964480 PMCID: PMC10038366 DOI: 10.1007/s40615-023-01576-8] [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: 11/01/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 03/26/2023]
Abstract
The purpose of this study was to understand the perceptions of HPV vaccination barriers and factors among parents or guardians of American Indian adolescents in the Cherokee Nation. Fifty-four parents of American Indian adolescents in the Cherokee Nation participated in one of eleven focus group discussions from June to August 2019. Discussions were recorded, transcribed, coded, and analyzed for themes. Protection against cancer was the primary parent-reported reason for vaccinating their children against HPV. The lack of information and safety concerns about the HPV vaccine were the main reasons for non-vaccination. To increase HPV vaccine uptake, parents strongly supported offering vaccinations in school. Furthermore, increased healthcare provider-initiated discussion can ease parental concerns about HPV vaccine safety and improve coverage.
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Affiliation(s)
- Sydney A Martinez
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Amber S Anderson
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | | | - Sameer V Gopalani
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Amanda E Janitz
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Janis E Campbell
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ashley H White
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
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Bressler SS, Bruden D, Hammitt LL, Chukwuma U, Fischer M, Singleton R. Trends in Otitis Media Ambulatory Visits in American Indian and Alaska Native Children During the Pneumococcal Conjugate Vaccine Period and the COVID-19 Pandemic. Pediatr Infect Dis J 2024; 43:390-392. [PMID: 38241660 PMCID: PMC10919265 DOI: 10.1097/inf.0000000000004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/21/2024]
Abstract
Otitis media-associated outpatient visits among American Indians/Alaska Natives children <5 years old decreased by 52% (100 to 48 per 100 children per year) from 2003 to 2019. Otitis media visits decreased by another 50% from 2019 to 2020, but rebounded between 2020 and 2021 back to a rate similar to 2019.
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Affiliation(s)
- Sara S. Bressler
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Dana Bruden
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Laura L. Hammitt
- Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Uzo Chukwuma
- Infectious Disease Branch, Office of Public Health Support, Indian Health Service, Rockville, Maryland
| | - Marc Fischer
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
| | - Rosalyn Singleton
- From the Centers for Disease Control and Prevention, Division of Infectious Disease Readiness and Innovation, Arctic Investigations Program, Anchorage, Alaska
- Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, Alaska
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Salimi N, Gere B, Shahab A. State-Federal Vocational Rehabilitation Services, Demographic Characteristics and Employment Outcomes for Native Americans with Mental Illnesses. Community Ment Health J 2024; 60:442-456. [PMID: 37828363 DOI: 10.1007/s10597-023-01191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
There were 9.7 million Native Americans (American Indian, Alaska Native-AI/AN- these acronyms will be used interchangeably with Native Americans throughout the paper) in 2019 comprising 2.9% of the U.S. population. Native American populations have disproportionately higher rates of mental illnesses compared to other racial groups in the U.S. Mental health is a significant public health concern for this population, impacting different areas of their lives including employment. Additionally, Native Americans continue to experience significant disparities in access to Vocational Rehabilitation (VR) services and have poor employment outcomes. However, little is known about the relationships among demographic factors, vocational rehabilitation services, and employment outcomes of Native Americans with mental illness. Consequently, the current study examined how demographic factors and VR services are related to successful employment outcomes for Native American VR clients with mental illnesses using data from the Rehabilitation Services Administration (RSA) program year (2019) Case Service Report (9-11). Both descriptive analysis and data mining approaches were used to answer the research questions. Chi-square Automatic Interaction Detector (CHAID) analysis was used to determine which of the VR services could best predict the successful employment outcome of Native Americans with mental illness. The findings of the data mining approach revealed that among all the vocational rehabilitation services, job placement assistance was the strongest predictor of successful employment among Native American clients with mental illnesses. The second most important service predicting successful employment for those who received job placement assistance was shown to be maintenance. Implications for rehabilitation counselors and future research are discussed.
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Affiliation(s)
- Nahal Salimi
- Rehabilitation Counseling & Disability Services, School of Interdisciplinary Health Professions, College of Health & Human Sciences, Northern Illinois University, 353 Wirtz Hall, DeKalb, IL, 60115, USA.
| | - Bryan Gere
- Department of Rehabilitation, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Hazel Hall #1109, Princess Anne, MD, 21853, USA
| | - Amin Shahab
- Department of Computer Science and Operations Research, Université de Montréal, Québec City, Canada
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Fernandez JM, Mata EM, Plampton K, Whitley MJ, Sutton AV, Wysong A. Melanoma characteristics and overall survival predictors in American Indians and Alaska Natives: An analysis of the national cancer database from 2004 to 2018. J Am Acad Dermatol 2024; 90:836-837. [PMID: 38043590 DOI: 10.1016/j.jaad.2023.11.045] [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] [Received: 07/27/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Jennifer M Fernandez
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth M Mata
- Department of Medicine, University of Arizona, College of Medicine - Tucson, Tucson, Arizona
| | - Katherine Plampton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; University of Minnesota Medical School, Minneapolis, Minnesota
| | - Melodi Javid Whitley
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska; Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Adam V Sutton
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska.
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Parker T, Kelley A, Cooeyate N, Tsosie N. Participatory training evaluation: Steps from the Center for Native American Health Native-CHART symposium. Eval Program Plann 2024; 103:102397. [PMID: 38185039 DOI: 10.1016/j.evalprogplan.2023.102397] [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: 10/04/2022] [Revised: 07/12/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024]
Abstract
This paper presents a case example of the Native-CHART Training Evaluation and describes the process of planning and administering a paper evaluation during the Native-CHART symposium in November 2019 led by the Center for Native American Health (CNAH) and an external evaluator. Training evaluation methodologies and the data collection instrument were grounded in the Health Belief Model (HBM) where health-related chronic disease and risk factor knowledge translates to perceived susceptibility, benefits, barriers, and self-efficacy. Kirkpatrick's Four-level Training Evaluation Model explored learning, reaction, behaviors, and results. The evaluation aims centered around the following questions: 1)Who attended the symposium, and why did they attend? 2)What knowledge did participants gain at the symposium? 3)Will attendees change their behaviors as a result of attending the symposium? 4) What parts of the symposium were most valuable? And 5) How can the symposium be improved? Data collected at the symposium answered these questions. After the Native-CHART symposium, CNAH staff and the external evaluator met to reflect on the steps necessary to plan and implement a participatory training evaluation. From these discussions, eight steps emerged. This paper presents these steps along with recommendations for future work. Participatory and collaborative approaches in training evaluation and the steps included in this case example may be useful to evaluators, communities, and programs working on designing and evaluating various trainings with Tribal populations.
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Affiliation(s)
- Tassy Parker
- Department of Family and Community Medicine, Center for Native American Health-a Public Health Institute for Indigenous Knowledge & Development, MSC07 4246 1001, Medical Arts Ave NE, Albuquerque, NM 87102, USA
| | - Allyson Kelley
- Allyson Kelley and Associates PLLC, PO Box 436 Sisters, OR 97759, USA.
| | - Norman Cooeyate
- Department of Family and Community Medicine, Center for Native American Health-a Public Health Institute for Indigenous Knowledge & Development, MSC07 4246 1001, Medical Arts Ave NE, Albuquerque, NM 87102, USA
| | - Nathania Tsosie
- Department of Family and Community Medicine, Center for Native American Health-a Public Health Institute for Indigenous Knowledge & Development, MSC07 4246 1001, Medical Arts Ave NE, Albuquerque, NM 87102, USA
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Ehlers CL, Gilder DA, Benedict J, Wills DN, Phillips E, Gonzales C, Karriker-Jaffe KJ, Bernert RA. Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents. Transcult Psychiatry 2024; 61:273-284. [PMID: 38311923 DOI: 10.1177/13634615241227679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n = 360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in "social zeitgebers" that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.
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Affiliation(s)
- Cindy L Ehlers
- Neurosciences Department, The Scripps Research Institute, USA
| | - David A Gilder
- Neurosciences Department, The Scripps Research Institute, USA
| | | | - Derek N Wills
- Neurosciences Department, The Scripps Research Institute, USA
| | - Evie Phillips
- Neurosciences Department, The Scripps Research Institute, USA
| | - Cathy Gonzales
- Neurosciences Department, The Scripps Research Institute, USA
- Pala Band of Mission Indians, Pala, CA, USA
| | | | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
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14
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Landis RK, Stein BD, Dick AW, Griffin BA, Saloner BK, Terplan M, Faherty LJ. Trends and Disparities in Perinatal Opioid Use Disorder Treatment in Medicaid, 2007-2012. Med Care Res Rev 2024; 81:145-155. [PMID: 38160405 DOI: 10.1177/10775587231216515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
We described Medicaid-insured women by receipt of perinatal opioid use disorder (OUD) treatment; and trends and disparities in treatment. Using 2007 to 2012 Medicaid Analytic eXtract data from 45 states and D.C., we identified deliveries among women with OUD. Regressions modeled the association between patient characteristics and receipt of any OUD treatment, medication for OUD (MOUD), and counseling alone during the perinatal period. Rates of any OUD treatment and MOUD for women with perinatal OUD increased over the study period, but trends differed by subgroup. Compared with non-Hispanic White women, Black and American Indian/Alaskan Native (AI/AN) women were less likely to receive any OUD treatment, and Black women were less likely to receive MOUD. Over time, the disparity in receipt of MOUD between Black and White women increased. Overall gains in OUD treatment were driven by improvements in perinatal OUD care for White women and obscured disparities for Black and AI/AN women.
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Affiliation(s)
| | | | | | | | | | | | - Laura J Faherty
- RAND Corporation, Boston, MA, USA
- Maine Medical Center, Portland, ME, USA
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15
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Gatewood A, Hendrix-Dicken AD, Hartwell M. Comparing Self-Reported and Aggregated Racial Classification for American Indian/Alaska Native Youths in YRBSS: 2021. Am J Public Health 2024; 114:403-406. [PMID: 38386969 PMCID: PMC10937599 DOI: 10.2105/ajph.2023.307561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Objectives. To identify how race and ethnicity were reclassified with survey variables for children self-reporting as American Indian/Alaska Native (AI/AN) using the 2021 Youth Risk Behavior Surveillance System (YRBSS). Methods. We conducted a cross-sectional analysis of the US Centers for Disease Control and Prevention's 2021 YRBSS. YRBSS collects behaviors and demographics of students in grades 9 through 12, including race and ethnicity via self-report, and then reclassifies data into a "raceeth" variable. To examine the classification of AI/AN in YRBSS, we compared AI/AN composition between self-report and raceeth variables. Results. A total of 816 adolescents self-reported as AI/AN alone (145; 17.70%), AI/AN alone with Hispanic/Latino background (246; 30.15%), or AI/AN in combination with 1 or more race (425; 52.08%). Of those, only 145 were classified as being AI/AN in the calculated raceeth variable. With YRBSS survey weighting, the percentage of AI/AN in the raceeth variable was 13.4%. Conclusions. Misclassification, noncollection, or the use of categories such as "other" and "multirace" without allowing disaggregation can misrepresent disease burden, morbidity, and mortality. Consequently, it is critical to disaggregate data to adequately capture race/ethnicity in self-report surveys and data sources. (Am J Public Health. 2024;114(4):403-406. https://doi.org/10.2105/AJPH.2023.307561).
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Affiliation(s)
- Ashton Gatewood
- Ashton Gatewood and Micah Hartwell are with the Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah. Amy D. Hendrix-Dicken is with the Department of Pediatrics, University of Oklahoma-Tulsa School of Community Medicine. Micah Hartwell is also with the Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa. Ashton Gatewood is an enrolled tribal member of Choctaw Nation of Oklahoma and a descendant of Chickasaw Nation. Amy D. Hendrix-Dicken is an enrolled tribal member of Cherokee Nation
| | - Amy D Hendrix-Dicken
- Ashton Gatewood and Micah Hartwell are with the Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah. Amy D. Hendrix-Dicken is with the Department of Pediatrics, University of Oklahoma-Tulsa School of Community Medicine. Micah Hartwell is also with the Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa. Ashton Gatewood is an enrolled tribal member of Choctaw Nation of Oklahoma and a descendant of Chickasaw Nation. Amy D. Hendrix-Dicken is an enrolled tribal member of Cherokee Nation
| | - Micah Hartwell
- Ashton Gatewood and Micah Hartwell are with the Office of Medical Student Research, Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah. Amy D. Hendrix-Dicken is with the Department of Pediatrics, University of Oklahoma-Tulsa School of Community Medicine. Micah Hartwell is also with the Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa. Ashton Gatewood is an enrolled tribal member of Choctaw Nation of Oklahoma and a descendant of Chickasaw Nation. Amy D. Hendrix-Dicken is an enrolled tribal member of Cherokee Nation
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16
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Suchy-Dicey AM, Vo TT, Oziel K, King R, Barbosa-Leiker C, Rhoads K, Verney S, Buchwald DS, French BF. Psychometric Properties of Controlled Oral Word Association (COWA) Test and Associations With Education and Bilingualism in American Indian Adults: The Strong Heart Study. Assessment 2024; 31:745-757. [PMID: 37338127 PMCID: PMC10840386 DOI: 10.1177/10731911231180127] [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: 06/21/2023]
Abstract
The Controlled Oral Word Association (COWA) test is used to assess phonemic fluency and executive function. Formal validation of test scores is important for accurate cognitive evaluation. However, there is a dearth of psychometric validation among American Indian adults. Given high burden of dementia risk and key contextual factors associated with cognitive assessments, this represents a critical oversight. In a large, longitudinal population-based cohort study of adult American Indians, we examined several validity inferences for COWA, including scoring, generalization, and extrapolation inferences, by investigation of factor structure, internal consistency, test-retest reliability, and differential test functioning. We found adequate unidimensional model fit, with high factor loadings. Internal consistency reliability and test-retest reliability were 0.88 and 0.77, respectively, for the full group. COWA scores were lowest among the oldest, lowest education, bilingual speakers; group effects for sex and bilingual status were small; age effect was medium; and education effect was largest. However, Wide Range Achievement Test (WRAT) score effect was stronger than education effect, suggesting better contextualization may be needed. These results support interpretation of total COWA score, including across sex, age, or language use strata.
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Affiliation(s)
| | - Thao T. Vo
- Washington State University, Seattle, USA
| | - Kyra Oziel
- Washington State University, Seattle, USA
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17
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Rechenmacher AJ, Case A, Wu M, Ryan SP, Seyler TM, Bolognesi MP. Outcome Disparities in Total Knee and Total Hip Arthroplasty among Native American Populations. J Racial Ethn Health Disparities 2024; 11:1106-1115. [PMID: 37036599 DOI: 10.1007/s40615-023-01590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND No prior racial disparities studies in total knee arthroplasty (TKA) and total hip arthroplasty (THA) have specifically evaluated outcomes among American Indian or Alaska Native (AIAN) patients. We hypothesized that AIAN patients have worse outcomes than White patients after controlling for demographics and comorbidities. METHODS This was a retrospective cohort study comparing White and AIAN patients undergoing primary TKA/THA from 2012-2019 using the American College of Surgeons National Surgical Quality Improvement Program. Race, demographics, and comorbidities were analyzed for correlations with 30-day outcomes and complications using multivariable logistic and linear regression analyses. RESULTS Comparing 422,215 White and 2,676 AIAN patients, AIAN patients had higher American Society of Anesthesiologist (ASA) classifications, body mass index (BMI), and were younger at the time of surgery. AIAN patients more often stayed inpatient > 2 days (49.4% vs 36.2%, p < 0.001), underwent reoperation (2.1% vs 1.4%, p < 0.01), and were discharged home (91.4% vs 81.7%, p < 0.01). Regression analyses controlling for age, BMI, sex, ASA classification, and functional status found that AIAN race was significantly positively correlated with a length of stay > 2 days (OR 1.6), reoperation (OR 1.4), and discharging home (OR 2.0). CONCLUSION AIAN patients undergoing TKA/THA present with a greater comorbidity burden compared to White patients and experience multiple worse outcome metrics including increased hospital length of stay and reoperation rates. Interestingly, AIAN patients were more likely to discharge home, representing a unique racial disparity which warrants further study.
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Affiliation(s)
- Albert J Rechenmacher
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Ayden Case
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Mark Wu
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
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18
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Renn T, Moore J, Schultz KA, Veeh CA. Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults. J Racial Ethn Health Disparities 2024; 11:685-695. [PMID: 36929492 DOI: 10.1007/s40615-023-01552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.
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Affiliation(s)
- Tanya Renn
- Florida State University College of Social Work, Tallahassee, FL, USA.
| | - John Moore
- Florida State University College of Social Work, Tallahassee, FL, USA
| | - Katie A Schultz
- Florida State University College of Social Work, Tallahassee, FL, USA
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19
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard DA, Buchwald D. Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic. BMC Public Health 2024; 24:903. [PMID: 38539099 PMCID: PMC10967146 DOI: 10.1186/s12889-024-18390-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. METHODS In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. RESULTS Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. CONCLUSIONS High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.
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Affiliation(s)
- Katie Nelson
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA.
| | | | - Cassandra J Nguyen
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Spero M Manson
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Denise A Dillard
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
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20
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Virtue C, Goffe C, Shiang E, McKenzie Z, Shields W. Surveillance methods and interventions implemented in American Indian and Alaska Native communities to increase child restraint device and seat belt use in motor vehicles: a systematic review. Inj Prev 2024; 30:92-99. [PMID: 38302282 DOI: 10.1136/ip-2023-045044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/03/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND American Indian/Alaska Native (AI/AN) children are disproportionately affected by injuries and deaths related to motor vehicle crashes. We aimed to synthesise published evidence on surveillance methods and interventions implemented in AI/AN communities and analyse characteristics that make them successful in increasing child restraint devices and seat belt use. METHODS Studies were collected from the PubMed, Scopus, and TRID databases and the CDC Tribal Road Safety website, Community Guide, and Indian Health Service registers. Included studies collected primary data on AI/AN children (0-17) and reported morbidity/mortality outcomes related to child restraint devices or seat belt use. Studies with poor methodological quality, published before 2002, whose data were collected outside of the USA, or were non-English, were excluded. Checklists from the Joanna Briggs Institute were used to assess the risk of bias. In the synthesis of results, studies were grouped by whether a surveillance method or intervention was employed. RESULTS The final review included 9 studies covering 72 381 participants. Studies conducted surveillance methods, interventions involving law enforcement only and multipronged interventions. Multipronged approaches were most effective by using the distribution of child restraint devices combined with at least some of the following components: educational programmes, media campaigns, enactment/enforcement of child passenger restraint laws, incentive programmes and surveillance. DISCUSSION Although this review was limited by the number and quality of included studies, available resources suggest that we need multipronged, culturally tailored and sustainable interventions fostered by mutually beneficial and trusting partnerships. Continued investment in AI/AN road safety initiatives is necessary.
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Affiliation(s)
- Cierra Virtue
- Family Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Chelsea Goffe
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Evelyn Shiang
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zoann McKenzie
- Injury Prevention Program, Indian Health Service, Rockville, Maryland, USA
| | - Wendy Shields
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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21
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Nanavati HD, Andrabi M, Arevalo YA, Liu E, Shen J, Lin C. Disparities in Race and Ethnicity Reporting and Representation for Clinical Trials in Stroke: 2010 to 2020. J Am Heart Assoc 2024; 13:e033467. [PMID: 38456461 PMCID: PMC11010007 DOI: 10.1161/jaha.123.033467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Racial and ethnic minority groups are at a higher stroke risk and have poor poststroke outcomes. The aim of this study was to assess the frequency of race reporting and proportions of race and ethnicity representation in stroke-related clinical trials. METHODS AND RESULTS This is a descriptive study of stroke-related clinical trials completed between January 1, 2010 and December 31, 2020, and registered on ClinicalTrials.gov. Trials conducted in the United States, related to stroke and enrolling participants ≥18 years, were considered eligible. Trials were reviewed for availability of published results, data on race and ethnicity distribution, and trial characteristics. Overall, 60.1% of published trials reported race or ethnicity of participants, with a 2.6-fold increase in reporting between 2010 and 2020. White patients represented 65.0% of the participants, followed by 24.8% Black, 2.4% Asian or Pacific Islander, and <1% Native American and multiracial participants; 9.0% were of Hispanic ethnicity. These trends remained consistent throughout the study period, except in 2018, when a higher proportion of Black participants (53.1%) was enrolled compared with White participants (35.8%). Trials with the National Institutes of Health/federal funding had higher enrollment of Black (28.1%) and Hispanic (13.8%) participants compared with other funding sources. Behavioral intervention trials had the most diverse enrollment with equal enrollment of Black and White participants (41.1%) and 14.5% Hispanic participants. CONCLUSIONS Despite the increase in race and ethnicity reporting between 2010 and 2020, the representation of racial and ethnic minority groups remains low in stroke trials. Funding initiatives may influence diversity efforts in trial enrollment.
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Affiliation(s)
- Hely D Nanavati
- Department of Epidemiology The University of Alabama at Birmingham Birmingham AL
| | - Mudasir Andrabi
- Capstone College of Nursing The University of Alabama Tuscaloosa AL
| | - Yurany A Arevalo
- Department of Neurology The University of Alabama at Birmingham Birmingham AL
| | - Evan Liu
- Heersink School of Medicine The University of Alabama at Birmingham Birmingham AL
| | - Jeffrey Shen
- Department of Rheumatology Duke University Durham NC
| | - Chen Lin
- Department of Neurology The University of Alabama at Birmingham Birmingham AL
- Birmingham VA Medical Center Birmingham AL
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22
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Reese JA, Roman MJ, Deen JF, Ali T, Cole SA, Devereux RB, Fretts AM, Howard WJ, Lee ET, Malloy K, Umans JG, Zhang Y. Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study. J Am Heart Assoc 2024; 13:e031741. [PMID: 38445515 PMCID: PMC11010025 DOI: 10.1161/jaha.123.031741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although many studies on the association between dyslipidemia and cardiovascular disease (CVD) exist in older adults, data on the association among adolescents and young adults living with disproportionate burden of cardiometabolic disorders are scarce. METHODS AND RESULTS The SHFS (Strong Heart Family Study) is a multicenter, family-based, prospective cohort study of CVD in an American Indian populations, including 12 communities in central Arizona, southwestern Oklahoma, and the Dakotas. We evaluated SHFS participants, who were 15 to 39 years old at the baseline examination in 2001 to 2003 (n=1440). Lipids were measured after a 12-hour fast. We used carotid ultrasounds to detect plaque at baseline and follow-up in 2006 to 2009 (median follow-up=5.5 years). We identified incident CVD events through 2020 with a median follow-up of 18.5 years. We used shared frailty proportional hazards models to assess the association between dyslipidemia and subclinical or clinical CVD, while controlling for covariates. Baseline dyslipidemia prevalence was 55.2%, 73.6%, and 78.0% for participants 15 to 19, 20 to 29, and 30 to 39 years old, respectively. Approximately 2.8% had low-density lipoprotein cholesterol ≥160 mg/dL, which is higher than the recommended threshold for lifestyle or medical interventions in young adults of 20 to 39 years old. During follow-up, 9.9% had incident plaque (109/1104 plaque-free participants with baseline and follow-up ultrasounds), 11.0% had plaque progression (128/1165 with both baseline and follow-up ultrasounds), and 9% had incident CVD (127/1416 CVD-free participants at baseline). Plaque incidence and progression were higher in participants with total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥160 mg/dL, or non-high-density lipoprotein cholesterol ≥130 mg/dL, while controlling for covariates. CVD risk was independently associated with low-density lipoprotein cholesterol ≥160 mg/dL. CONCLUSIONS Dyslipidemia is a modifiable risk factor that is associated with both subclinical and clinical CVD, even among the younger American Indian population who have unexpectedly high rates of significant CVD events. Therefore, this population is likely to benefit from a variety of evidence-based interventions including screening, educational, lifestyle, and guideline-directed medical therapy at an early age.
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Affiliation(s)
- Jessica A Reese
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | | | - Jason F Deen
- Departments of Pediatrics and Medicine University of Washington Seattle WA USA
| | - Tauqeer Ali
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Shelley A Cole
- Population Health Texas Biomedical Research Institute San Antonio TX USA
| | | | - Amanda M Fretts
- Department of Epidemiology University of Washington Seattle WA USA
| | - Wm James Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science Washington DC USA
| | - Elisa T Lee
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Kimberly Malloy
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
| | - Jason G Umans
- MedStar Health Research Institute Hyattsville MD USA
- Georgetown-Howard Universities Center for Clinical and Translational Science Washington DC USA
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, Hudson College of Public Health University of Oklahoma Health Sciences Center Oklahoma City OK USA
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23
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Brower MC. Native American Cosmological Ideas: Dimensions of Depth in Social Work. Soc Work 2024; 69:201-203. [PMID: 38396105 DOI: 10.1093/sw/swae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/17/2023] [Accepted: 06/21/2023] [Indexed: 02/25/2024]
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24
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Sheehan A, Walsh R, Liu R. Racial and ethnic trends in mental health service utilisation and perceived unmet need in the USA. J Epidemiol Community Health 2024; 78:228-234. [PMID: 38242681 PMCID: PMC10988996 DOI: 10.1136/jech-2023-220683] [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: 04/04/2023] [Accepted: 12/08/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Two decades ago, the Surgeon General issued a report highlighting concerning disparities in mental healthcare among racial and ethnic minority populations. The present study characterised national trends in mental health treatment utilisation by race and ethnicity across a 13-year period. METHODS Nationally representative data were drawn from the National Survey on Drug Use and Health from 2008 through 2020 (unweighted n=4 41 993). Trends in mental health treatment utilisation and perceived unmet treatment need among individuals with and without psychiatric illness were stratified by race and ethnicity. RESULTS Logistic regression analyses revealed most racial/ethnic minority groups were less likely to receive treatment than white individuals, regardless of mental health status. Treatment utilisation increased among those with (annual per cent change (APC)=0.83, 95% CI=0.41 to 1.26) and without psychiatric illness (APC=1.39, 95% CI=0.53 to 2.26). Among individuals with psychiatric illness, treatment use increased among white (APC=0.88, 95% CI=0.51 to 1.24), Hispanic (APC=2.12, 95% CI=0.70 to 3.57) and black adults (APC=1.07, 95% CI=0.11 to 2.04). White (APC=1.88, 95% CI=0.86 to 2.91) and Hispanic (APC=2.45, 95% CI=0.02 to 4.93) individuals without psychiatric illness also saw increased treatment use. Although increases in perceived unmet treatment need were observed for all racial and ethnic groups except blacks and Native Americans with psychiatric illness, rates remained low across all groups. CONCLUSIONS Although national rates of mental health treatment utilisation have risen, this was almost entirely observed among white and Hispanic individuals with and without psychiatric illness, highlighting the limited progress made towards eliminating disparities in care.
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Affiliation(s)
- Ana Sheehan
- Department of Psychological, University of Delaware, Newark, Delaware, USA
| | - Rachel Walsh
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Richard Liu
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
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Mueller-Williams AC, Coughlin LN, Goldstick JE. Unpacking Firearm Access and Firearm Violence Exposure Among American Indian or Alaskan Native and Black Adults. JAMA Netw Open 2024; 7:e240020. [PMID: 38436961 DOI: 10.1001/jamanetworkopen.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Affiliation(s)
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor
- Michigan Innovations in Addiction Care Through Research and Education, University of Michigan, Ann Arbor
- Injury Prevention Center, University of Michigan, Ann Arbor
| | - Jason E Goldstick
- Injury Prevention Center, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor
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Adia AC, Nguyen KH, Ponce NA. EHR Data and Inclusion of Multiracial Asian American, Native Hawaiian, and Pacific Islander People-Opportunities for Advancing Data-Centered Equity in Health Research. JAMA Netw Open 2024; 7:e240719. [PMID: 38502131 DOI: 10.1001/jamanetworkopen.2024.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
| | - Kevin H Nguyen
- School of Public Health, Boston University, Boston, Massachusetts
| | - Ninez A Ponce
- Fielding School of Public Health, University of California, Los Angeles
- Center for Health Policy Research, University of California, Los Angeles
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Anestis MD, Moceri-Brooks J, Ziminski D, Barnes RT, Semenza D. Firearm Access and Gun Violence Exposure Among American Indian or Alaska Native and Black Adults. JAMA Netw Open 2024; 7:e240073. [PMID: 38436959 PMCID: PMC10912965 DOI: 10.1001/jamanetworkopen.2024.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/18/2023] [Indexed: 03/05/2024] Open
Abstract
Importance American Indian or Alaska Native and Black adults experience elevated rates of firearm injury and death, but both groups are severely underrepresented in research on firearm exposure and behaviors. Objective To explore geodemographic differences in firearm behaviors and violence exposure among American Indian or Alaska Native and Black adults in the US. Design, Setting, and Participants In this survey study, nationally representative samples of American Indian or Alaska Native and/or Black adults recruited from KnowledgePanel were surveyed cross-sectionally. Surveys were administered online between April 12 and May 4, 2023. Main Outcomes and Measures Firearm access, storage, and carrying behaviors and lifetime firearm violence exposure were the primary outcomes. Demographic factors such as age, geographic location, and political affiliation were considered. Data were weighted to geodemographic distributions from the US Census Bureau's 2022 Current Population Survey. Results Of 3542 participants, 527 (14.9%) were American Indian or Alaska Native (280 [53.1%] female) and 3015 (85.1%) were Black (1646 [54.6%] female). Both groups exhibited high firearm access rates (American Indian or Alaska Native adults: 238 [45.4%; 95% CI, 39.4%-51.7%]; Black adults: 909 [30.4%; 95% CI, 28.0%-32.9%]), predominantly owning handguns for home protection. The groups demonstrated similar firearm storage patterns, and a substantial proportion endorsed always or almost always carrying firearms outside the home (American Indian or Alaska Native adults: 18.9%; Black adults: 15.2%). Self-protection was a common reason for carrying a firearm (American Indian or Alaska Native adults: 104 [84.9%; 95% CI, 74.1%-91.7%]; Black adults: 350 [88.3%; 95% CI, 82.3%-92.4%]), and a minority of participants cited lack of faith in the police (American Indian or Alaska Native adults: 19 [15.2%; 95% CI, 8.2%-26.7%]; Black adults: 61 [15.4%; 95% CI, 10.3%-21.2%]), indicating potential shifts in public safety dynamics. Conclusions and Relevance In this survey study of American Indian or Alaska Native and Black US adults, a substantial percentage of both groups reported living in homes with firearms, storing firearms loaded and unlocked, frequently carrying firearms outside the home, and having been exposed directly and indirectly to gun violence. These findings underscore the need for nuanced public health campaigns and policies and highlight challenges for law enforcement in contexts of racial disparities and changing legal frameworks.
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Affiliation(s)
- Michael D. Anestis
- New Jersey Gun Violence Research Center, Rutgers, The State University of New Jersey, Piscataway
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway
| | - Jayna Moceri-Brooks
- New Jersey Gun Violence Research Center, Rutgers, The State University of New Jersey, Piscataway
| | - Devon Ziminski
- New Jersey Gun Violence Research Center, Rutgers, The State University of New Jersey, Piscataway
- Senator Walter Rand Institute for Public Affairs, Rutgers University–Camden, Cinnaminson, New Jersey
| | - R. Thurman Barnes
- New Jersey Gun Violence Research Center, Rutgers, The State University of New Jersey, Piscataway
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway
| | - Daniel Semenza
- New Jersey Gun Violence Research Center, Rutgers, The State University of New Jersey, Piscataway
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University–Camden, Cinnaminson, New Jersey
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Wen X, Fretts AM, Miao G, Malloy KM, Zhang Y, Umans JG, Cole SA, Best LG, Fiehn O, Zhao J. Plasma lipidomic markers of diet quality are associated with incident coronary heart disease in American Indian adults: the Strong Heart Family Study. Am J Clin Nutr 2024; 119:748-755. [PMID: 38160800 DOI: 10.1016/j.ajcnut.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Identifying lipidomic markers of diet quality is needed to inform the development of biomarkers of diet, and to understand the mechanisms driving the diet- coronary heart disease (CHD) association. OBJECTIVES This study aimed to identify lipidomic markers of diet quality and examine whether these lipids are associated with incident CHD. METHODS Using liquid chromatography-mass spectrometry, we measured 1542 lipid species from 1694 American Indian adults (aged 18-75 years, 62% female) in the Strong Heart Family Study. Participants were followed up for development of CHD through 2020. Information on the past year diet was collected using the Block Food Frequency Questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index-2010 (AHEI). Mixed-effects linear regression was used to identify individual lipids cross-sectionally associated with AHEI. In prospective analysis, Cox frailty model was used to estimate the hazard ratio (HR) of each AHEI-related lipid for incident CHD. All models were adjusted for age, sex, center, education, body mass index, smoking, alcohol drinking, level of physical activity, energy intake, diabetes, hypertension, and use of lipid-lowering drugs. Multiple testing was controlled at a false discovery rate of <0.05. RESULTS Among 1542 lipid species measured, 71 lipid species (23 known), including acylcarnitine, cholesterol esters, glycerophospholipids, sphingomyelins and triacylglycerols, were associated with AHEI. Most of the identified lipids were associated with consumption of ω-3 (n-3) fatty acids. In total, 147 participants developed CHD during a mean follow-up of 17.8 years. Among the diet-related lipids, 10 lipids [5 known: cholesterol ester (CE)(22:5)B, phosphatidylcholine (PC)(p-14:0/22:1)/PC(o-14:0/22:1), PC(p-38:3)/PC(o-38:4)B, phosphatidylethanolamine (PE)(p-18:0/20:4)/PE(o-18:0/20:4), and sphingomyelin (d36:2)A] were associated with incident CHD. On average, each standard deviation increase in the baseline level of these 5 lipids was associated with 17%-23% increased risk of CHD (from HR: 1.17; 95% CI: 1, 1.36; to HR: 1.23; 95% CI: 1.05, 1.43). CONCLUSIONS In this study, lipidomic markers of diet quality in American Indian adults are found. Some diet-related lipids are associated with risk of CHD beyond established risk factors.
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Affiliation(s)
- Xiaoxiao Wen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States; Center for Genetic Epidemiology and Bioinformatics, University of Florida, Gainesville, FL, United States
| | - Amanda M Fretts
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Guanhong Miao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States; Center for Genetic Epidemiology and Bioinformatics, University of Florida, Gainesville, FL, United States
| | - Kimberly M Malloy
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ying Zhang
- Center for American Indian Health Research, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jason G Umans
- Biomarker, Biochemistry, and Biorepository Core, MedStar Health Research Institute, Hyattsville, MD, United States; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States
| | - Shelley A Cole
- Population Health, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Lyle G Best
- Missouri Breaks Industries Research, Timber Lake, SD, United States
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California-Davis, Davis, CA, United States
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States; Center for Genetic Epidemiology and Bioinformatics, University of Florida, Gainesville, FL, United States.
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Close RM, Lutz CS, Jones TS, Stone M, Bratsch N, Thompson T, Jentoft C, McAuley JB. Characteristics and outcomes of a hospitalized cohort with reduced mortality from COVID-19, White Mountain apache tribal lands, April 1 - July 31, 2020. BMC Public Health 2024; 24:648. [PMID: 38424548 PMCID: PMC10905852 DOI: 10.1186/s12889-024-18098-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Widespread transmission of COVID-19 continues to threaten public health, particularly of rural, American Indian communities. Although COVID-19 risk factors for severe disease and clinical characteristics are well described in the general population, there has been little shared on hospitalized American Indian populations. METHODS In this observational study, we performed chart extractions on all persons hospitalized with COVID-19 from April 1 through July 31, 2020 among an exclusively American Indian population living on or near Tribal lands in eastern Arizona. We provide descriptive statistics for the cohort stratified by presentation, comparing those who self-presented or were referred by an outreach program. Exploratory analyses were performed to identify risk factors for morbidity and mortality. RESULTS During the observation period, 2262 persons were diagnosed with COVID-19 and 490 (22%) were hospitalized. Hospitalized persons had a median age of 54 years; 92% had at least one comorbidity, 72% had greater than one comorbidity, and 60% had a BMI of > 30. Most persons required supplemental oxygen (83%), but the majority (62%) only required nasal cannula and only 11% were intubated. The case fatality rates were 1.7% for the population, 7.1% among hospitalizations, and 9.3% among hospitalized patients 50 years and older. All rates that are significantly lower than those reported nationally during the same period. CONCLUSIONS We observed a cohort of American Indian patients hospitalized secondary to COVID-19 with greater number of comorbidities compared to the general population but with lower mortality rates. We posit that the primary driver of mortality reduction for this population and the hospitalized cohort was a community-based referral program that led to disproportionately lower fatality rates among the oldest persons.
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Affiliation(s)
- Ryan M Close
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA.
- Maine Medical Center, MaineHealth, Portland, ME, USA.
| | - Chelsea S Lutz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Shaifer Jones
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - Myles Stone
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Nicole Bratsch
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - Trevor Thompson
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
- United States Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Christopher Jentoft
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
| | - James B McAuley
- Whiteriver Service Unit, Indian Health Service, 200 W. Hospital Drive, Whiteriver, AZ, 85941, USA
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Kulis SS, Tsethlikai M, Ayers SL, Gresenz KE. Parenting in 2 Worlds: Testing improved parent-adolescent communication about sexuality in Urban American Indian families. J Res Adolesc 2024; 34:56-68. [PMID: 37957746 PMCID: PMC10926230 DOI: 10.1111/jora.12900] [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: 03/22/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
Urban American Indian (AI) adolescents are more likely than non-Natives to have early sexual debut, teen pregnancies, sexually transmitted infections, and inadequate sexual health information. A RCT in three Arizona cities, with 585 parents of urban AI adolescents, tested whether a culturally tailored parenting intervention for urban AI families, Parenting in 2 Worlds (P2W), increased parent-adolescent communication about sexuality, compared to an informational family health intervention that was not culturally tailored. P2W produced significantly larger increases on two measures: communication about general sexual health and about sexual decision-making. The desired effects of P2W on the first measure were stronger short-term for cross-gender dyads, while for the second measure, they were stronger long-term for both mothers and fathers of adolescent sons.
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Affiliation(s)
- Stephen S. Kulis
- School of Social and Family Dynamics, Arizona State
University
- Global Center for Applied Health Research, Arizona State
University
| | | | | | - Kyle E. Gresenz
- School of Social and Family Dynamics, Arizona State
University
- Global Center for Applied Health Research, Arizona State
University
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Bremer MN, Gama GJ, Golts S, Lin CM, Kafi A, Yung G, Golts E, Afshar K. Outcomes following lung transplantation for American Indians/Alaska Natives in the United States. J Heart Lung Transplant 2024; 43:519-522. [PMID: 37972827 DOI: 10.1016/j.healun.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
Limited data is available for American Indians/Alaska Natives (AI/AN) undergoing lung transplant. The goal of our study was to assess outcomes for AI/AN lung transplant recipients (LTR). A retrospective review of data from the Organ Procurement and Transplant Network was performed comparing AI/AN (n = 88) and Caucasian (n = 22,767) LTRs between May 4, 2005 and October 31, 2019. AI/AN LTRs had worse functional parameters prior to transplantation but had similar post-transplant outcomes compared to Caucasians LTRs.
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Affiliation(s)
| | - Garrick J Gama
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Christine M Lin
- UC San Diego School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California
| | - Aarya Kafi
- UC San Diego School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California
| | - Gordon Yung
- UC San Diego School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California
| | - Eugene Golts
- UC San Diego School of Medicine, Department of Cardiothoracic Surgery, La Jolla, California
| | - Kamyar Afshar
- UC San Diego School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, La Jolla, California
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Suchy‐Dicey AM, Longstreth WT, Rhoads K, Umans J, Buchwald D, Grabowski T, Blennow K, Reiman E, Zetterberg H. Plasma biomarkers of Alzheimer's disease and related dementias in American Indians: The Strong Heart Study. Alzheimers Dement 2024; 20:2072-2079. [PMID: 38215191 PMCID: PMC10984473 DOI: 10.1002/alz.13664] [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: 06/29/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Identification of Alzheimer's disease (AD) needs inexpensive, noninvasive biomarkers, with validation in all populations. METHODS We collected plasma markers in older American Indian individuals: phosphorylated-tau181 (pTau181); amyloid-beta (Aβ) 40,42; glial fibrillary acidic protein (GFAP); and neurofilament light chain (NfL). Plasma markers were analyzed for discriminant properties with cognitive status and etiology using receiver operating characteristic (ROC) analysis. RESULTS PTau181, GFAP, NfL plasma values were significantly associated with cognition, but Aβ were not. Discriminant performance was moderate for individual markers, with pTau181, GFAP, NfL performing best, but an empirically selected panel of markers (age, sex, education, pTau181, GFAP, NfL, Aβ4240 ratio) had excellent discriminant performance (AUC > 0.8). DISCUSSION In American Indian individuals, pTau181 and Aβ values suggested more common pathology than in majority populations. Aβ was less informative than in other populations; however, all four markers were needed for a best-performing dementia diagnostic model. These data validate utility of AD plasma markers, while suggesting population-specific diagnostic characteristics.
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Affiliation(s)
- Astrid M. Suchy‐Dicey
- Washington State University Elson S Floyd College of MedicineSpokaneWashingtonUSA
- Huntington Medical Research InstitutesPasadenaCaliforniaUSA
- Washington State University Institute for Research and Education to Address Community HealthSeattleWashingtonUSA
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
| | - W. T. Longstreth
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kristoffer Rhoads
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Jason Umans
- MedStar Health Research InstituteHyattsvilleMarylandUSA
| | - Dedra Buchwald
- Washington State University Institute for Research and Education to Address Community HealthSeattleWashingtonUSA
| | - Thomas Grabowski
- University of Washington Alzheimer's Disease Research CenterSeattleWashingtonUSA
- Department of NeurologyUniversity of WashingtonSeattleWashingtonUSA
| | - Kaj Blennow
- Institute of Neuroscience and Physiologythe Sahlgrenska Academy at University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
| | - Eric Reiman
- Banner Alzheimer's InstitutePhoenixArizonaUSA
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiologythe Sahlgrenska Academy at University of GothenburgMölndalSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
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Bauer KL, Mitchell AL, Mays GP. Examining Characteristics of Local Public Health Systems With Exceptional Tribal Organization Participation. J Public Health Manag Pract 2024; 30:274-284. [PMID: 38030145 PMCID: PMC10833201 DOI: 10.1097/phh.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To learn feasible ways to increase multisector community partnership with tribal organizations, meaning tribal health authorities or American Indian and Alaska Native (AI/AN)-serving organizations, by examining characteristics of local public health systems with exceptional tribal organization participation. DESIGN, SETTING, AND PARTICIPANTS In total, 728 local public health departments were surveyed in 2018 to generate a nationally representative sample of local public health systems in the United States. A positive deviance approach using logistic regression helped identify local public health systems that had tribal organization participation despite characteristics that make such participation statistically unlikely. Local public health systems with exceptional tribal organization participation were compared with systems with conventional participation, examining measures known to impact the formation of public health partnerships. MAIN OUTCOME MEASURE This study used an exploratory logistic regression approach to identify unique characteristics of local public health systems with exceptional tribal organization participation. RESULTS Of 728 health systems surveyed, 21 were identified as having exceptional tribal organization participation. Across varying thresholds to identify exceptional participation, having a higher network density and prioritizing equity in public health activities were found to consistently distinguish exceptional tribal organization participation in both nonrural and rural areas. CONCLUSIONS Public health partnerships with tribal organizations are possible even in circumstances that make them unlikely. Efforts to build denser networks of collaborating organizations and prioritize equity may help public health systems achieve success with tribal organization partnerships.
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Affiliation(s)
- Kyla L. Bauer
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amelia L. Mitchell
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Glen P. Mays
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA. Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study. Chest 2024; 165:716-724. [PMID: 37898186 DOI: 10.1016/j.chest.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. RESEARCH QUESTION How do American Indian and Alaska Native adults perceive and use lung cancer screening? STUDY DESIGN AND METHODS We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. RESULTS Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. INTERPRETATION Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.
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Affiliation(s)
- Allison C Welch
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Candice L Wilshire
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Gary Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Cole Allick
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Jed A Gorden
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.
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Demblowski LA, Steinberg SM, Meseroll RA, Santangelo GM, Zeiger MA. National Institutes of Health Funding for Surgeon-Scientists in the US-An Update and an Expanded Landscape. JAMA Surg 2024; 159:323-330. [PMID: 38265793 DOI: 10.1001/jamasurg.2023.7167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Importance Current reports suggest that the surgeon-scientist phenotype is significantly threatened. However, a significant increase in the proportion of surgeons in the workforce funded by the National Institutes of Health (NIH) from 2010 (0.5%) to 2020 (0.7%) was recently reported and showed that surgeons primarily performed basic science research (78% in 2010; 73% in 2020) rather than clinical research. Objective To provide an update on the status of surgeons funded by the NIH for fiscal year (FY) 2022. Evidence Review NIH-funded surgeons were identified in FY2012 and FY2022, including those who were awarded grants with more than 1 principal investigator (PI) by querying the internal database at the NIH. The main outcome for this study was the total number of NIH-funded surgeons in FY2012 and FY2022, including total grant costs and number of grants. The secondary analysis included self-reported demographic characteristics of the surgeons in FY2022. The research type (basic science vs clinical) of R01 grants was also examined. Findings Including multiple PI grants, 1324 surgeon-scientists were awarded $1.3 billion in FY2022. Women surgeons increased to 31.3% (339 of 1084) of the population of surgeon PIs in FY2022 compared with 21.0% (184 of 876) in FY2012. Among surgeon PIs awarded grants, a total of 200 (22.8%) were Asian, 35 (4.0%) were Black or African American, 18 (2.1%) were another race (including American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and more than 1 race), and 623 (71.1%) were White. A total of 513 of 689 R01 grants (74.5%) were for basic science, 131 (19.0%) were for clinical trials, and 45 (6.5%) were for outcomes research. Conclusions and Relevance NIH-funded surgeons are increasing in number and grant costs, including the proportion of women surgeon PIs, and are representative of the diversity among US academic surgical faculty. The results of this study suggest that despite the many obstacles surgeon-scientists face, their research portfolio continues to grow, they perform a myriad of mostly basic scientific research as both independent PIs and on multidisciplinary teams.
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Affiliation(s)
- Lindsay A Demblowski
- Office of Surgeon-Scientist Career Development, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Rebecca A Meseroll
- Office of Portfolio Analysis, Division of Program Coordination, Planning and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | - George M Santangelo
- Office of Portfolio Analysis, Division of Program Coordination, Planning and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, Maryland
| | - Martha A Zeiger
- Office of Surgeon-Scientist Career Development, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Conniff KR, Grill JD, Gillen DL. Retention of American Indian and Alaska Native participants in the National Alzheimer's Coordinating Center Uniform Data Set. Alzheimers Dement 2024; 20:1601-1613. [PMID: 38053483 PMCID: PMC10984415 DOI: 10.1002/alz.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/06/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION The number of American Indian and Alaska Native (AI/AN) elders is expected to double by 2060. Thus it is imperative to retain AI/AN participants in longitudinal research studies to identify novel risk factors and potential targets for intervention for Alzheimer's disease and related dementias in these communities. METHODS The National Alzheimer's Coordinating Center houses uniformly collected longitudinal data from the network of National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADRCs). We used logistic regression to quantify participant retention at 43 ADRCs, comparing self-identified AI/AN participants to non-Hispanic White (NHW) participants, adjusting for potential confounding factors including baseline diagnosis, age, sex, education, and smoking. RESULTS The odds of AI/AN participant retention at the first follow-up visit were significantly lower than those for NHW participants (adjusted odds ratio [aOR]: 0.599; 95%: 0.46-0.78; p < 0.001). DISCUSSION These results suggest the need for improved strategies to retain AI/AN participants, perhaps including improved researcher-community relationships and community engagement and education. HIGHLIGHTS American Indian and Alaska Native (AI/AN) research participants were retained to the first follow-up appointment at lower rates than non-Hispanic White (NHW) participants. AI/AN participants are retained at lower rates than NHW participants for long-term follow-up. The majority of AI/AN participants were not retained to the second follow-up visit.
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Affiliation(s)
- Kyle R. Conniff
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Joshua D. Grill
- Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
| | - Daniel L. Gillen
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
- Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
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George CM, Zacher T, Endres K, Richards F, Bear Robe L, Harvey D, Best LG, Red Cloud R, Black Bear A, Skinner L, Cuny C, Rule A, Schwab KJ, Gittelsohn J, Glabonjat RA, Schilling K, O’Leary M, Thomas ED, Umans J, Zhu J, Moulton LH, Navas-Acien A. Effect of an Arsenic Mitigation Program on Arsenic Exposure in American Indian Communities: A Cluster Randomized Controlled Trial of the Community-Led Strong Heart Water Study Program. Environ Health Perspect 2024; 132:37007. [PMID: 38534131 PMCID: PMC10967367 DOI: 10.1289/ehp12548] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Chronic arsenic exposure has been associated with an increased risk of cardiovascular disease; diabetes; cancers of the lung, pancreas and prostate; and all-cause mortality in American Indian communities in the Strong Heart Study. OBJECTIVE The Strong Heart Water Study (SHWS) designed and evaluated a multilevel, community-led arsenic mitigation program to reduce arsenic exposure among private well users in partnership with Northern Great Plains American Indian Nations. METHODS A cluster randomized controlled trial (cRCT) was conducted to evaluate the effectiveness of the SHWS arsenic mitigation program over a 2-y period on a) urinary arsenic, and b) reported use of arsenic-safe water for drinking and cooking. The cRCT compared the installation of a point-of-use arsenic filter and a mobile Health (mHealth) program (3 phone calls; SHWS mHealth and Filter arm) to a more intensive program, which included this same program plus three home visits (3 phone calls and 3 home visits; SHWS Intensive arm). RESULTS A 47% reduction in urinary arsenic [geometric mean ( GM ) = 13.2 to 7.0 μ g / g creatinine] was observed from baseline to the final follow-up when both study arms were combined. By treatment arm, the reduction in urinary arsenic from baseline to the final follow-up visit was 55% in the mHealth and Filter arm (GM = 14.6 to 6.55 μ g / g creatinine) and 30% in the Intensive arm (GM = 11.2 to 7.82 μ g / g creatinine). There was no significant difference in urinary arsenic levels by treatment arm at the final follow-up visit comparing the Intensive vs. mHealth and Filter arms: GM ratio of 1.21 (95% confidence interval: 0.77, 1.90). In both arms combined, exclusive use of arsenic-safe water from baseline to the final follow-up visit significantly increased for water used for cooking (17% to 53%) and drinking (12% to 46%). DISCUSSION Delivery of the interventions for the community-led SHWS arsenic mitigation program, including the installation of a point-of-use arsenic filter and a mHealth program on the use of arsenic-safe water (calls only, no home visits), resulted in a significant reduction in urinary arsenic and increases in reported use of arsenic-safe water for drinking and cooking during the 2-y study period. These results demonstrate that the installation of an arsenic filter and phone calls from a mHealth program presents a promising approach to reduce water arsenic exposure among private well users. https://doi.org/10.1289/EHP12548.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francine Richards
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Lisa Bear Robe
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | | | - Lyle G. Best
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Reno Red Cloud
- Environmental Resource Department, Oglala Sioux Tribe, Pine Ridge, South Dakota, USA
| | | | - Leslie Skinner
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Christa Cuny
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellogg J. Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ronald Alexander Glabonjat
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kathrin Schilling
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, South Dakota, USA
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason Umans
- Biomarker, Biochemistry, and Biorepository Core, Medstar Health, Washington, District of Columbia, USA
- Department of Medicine, School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Jianhui Zhu
- Biomarker, Biochemistry, and Biorepository Core, Medstar Health, Washington, District of Columbia, USA
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, New York, USA
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McKinley CE, Saltzman LY, Theall KP. The Weaving Healthy Families program: Promoting parenting practices, family resilience, and communal mastery. Fam Process 2024; 63:97-112. [PMID: 36710265 PMCID: PMC10382600 DOI: 10.1111/famp.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Parenting quality, family resilience, and community resilience and support have been found to be primary protective factors for the disproportionate burden of anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), depression, and suicide that US Indigenous youth and adults tend to experience. The purpose of this research study was to examine pilot results for outcomes related to relational factors for Indigenous family members who participated in the Weaving Healthy Families (WHF) program (translated to Chukka Auchaffi' Natana, in the Choctaw tribal language), a culturally grounded and empirically informed program geared toward promoting wellness, family resilience, parenting practices, and community resilience while also preventing SUD and violence. This nonrandomized pre-experimental pilot intervention followed a longitudinal design, which included pre-test, a post-test, and a 6-, 9-, and 12-month post-intervention follow-up surveys. Repeated-measures regressions were utilized with generalized estimating equations (GEE) to examine changes in parenting, family resilience, and communal mastery before and after the intervention for 24 adults and adolescents (12-17) across eight tribal families. Results indicate that the overall quality of parenting improved, as measured by improved parental monitoring and reductions in inconsistent discipline and corporal punishment. We identified sex differences in positive parenting, poor monitoring, and corporal punishment, with greater decreases in these measures among males over time. Family resilience and communal mastery improved for adolescent and adult participants after the WHF program. Our results indicate promising improvements across relational, familial, and community ecological, which provide clear clinical implications.
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Affiliation(s)
| | - Leia Y. Saltzman
- Tulane University School of Social Work, New Orleans, Louisiana, USA
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Semenza DC, Hamilton JL, Testa A, Jackson DB. Individual and cumulative firearm violence exposure: Implications for sleep among Black and American Indian/Alaska Native adults. Ann Epidemiol 2024; 91:18-22. [PMID: 38244953 DOI: 10.1016/j.annepidem.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE We investigated the relationship between various forms of firearm violence exposure and sleep problems among nationally representative samples of Black (N = 3015) and American Indian and Alaska Native (AI/AN) (N = 527) adults, focusing on difficulties falling asleep, staying asleep, and waking too early. Survey data were collected in April and May 2023. METHODS We employed negative binomial regression models to analyze the associations between the different types of firearm violence exposure and sleep problems. We further examined associations between cumulative firearm violence exposure and sleep outcomes. RESULTS A substantial proportion of Black (59%) and AI/AN (56%) adults reported experiencing some form of firearm violence exposure. Being threatened with a firearm emerged as a consistent factor associated with sleep problems for both racial groups. Witnessing or hearing about shootings was linked to sleep problems in the Black sample, while cumulative firearm violence exposure was associated with all sleep problems in both groups. CONCLUSIONS Individual and cumulative firearm violence exposure is associated with increased sleep problems among Black and AI/AN adults.
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Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ, USA; Department of Urban-Global Public Health, Rutgers University, Piscataway, NJ, USA; New Jersey Gun Violence Research Center, Rutgers University, Piscataway, NJ, USA.
| | | | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Maryland, MD, USA
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40
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Buck DiSilvestro J, Ulmer KK, Hedges M, Kardonsky K, Bruegl AS. Cervical Cancer: Preventable Deaths Among American Indian/Alaska Native Communities. Obstet Gynecol Clin North Am 2024; 51:125-141. [PMID: 38267123 DOI: 10.1016/j.ogc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
American Indian/Alaska Native (AI/AN) individuals have twice the mortality rate of cervical cancer than the general US population. Participation in prevention programs such as cervical cancer screening and human papillomavirus (HPV) vaccination are under-utilized in this population. There are high rates of established cervical cancer risk factors among this community, with AI/AN people having a higher likelihood of infection with high-risk HPV strains not included in the 9-valent vaccine. There is a need for more robust and urgent prevention and treatment efforts in regard to cervical cancer in the AI/AN community.
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Affiliation(s)
- Jessica Buck DiSilvestro
- Brown University, Providence, RI, USA; Women & Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| | - Keely K Ulmer
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | | | - Kimberly Kardonsky
- Department of Family Medicine, University of Washington School of Medicine, Heath Sciences Center, E-304 Box 356391, Seattle, WA 98195, USA
| | - Amanda S Bruegl
- Division of Gynecologic Oncology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mailstop L466, Portland, OR 97239, USA
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41
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Strully KW, Chatterji P, Liu H, Han S, Schell L. Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women. Health Aff (Millwood) 2024; 43:344-353. [PMID: 38437603 DOI: 10.1377/hlthaff.2023.00672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.
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Affiliation(s)
- Kate W Strully
- Kate W. Strully, State University of New York at Albany, Albany, New York
| | | | - Han Liu
- Han Liu, State University of New York at Albany
| | - Soojin Han
- Soojin Han, State University of New York at Albany
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Held S, Feng D, McCormick A, Schure M, Other Medicine L, Hallett J, Inouye J, Allen S, Holder S, Bull Shows B, Trottier C, Kyro A, Kropp S, Turns Plenty N. The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation. Int J Environ Res Public Health 2024; 21:285. [PMID: 38541285 PMCID: PMC10970069 DOI: 10.3390/ijerph21030285] [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] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
Indigenous people in Montana are disproportionately affected by chronic illness (CI), a legacy of settler colonialism. Existing programs addressing CI self-management are not appropriate because they are not consonant with Indigenous cultures in general and the Apsáalooke culture specifically. A research partnership between the Apsáalooke (Crow Nation) non-profit organization Messengers for Health and Montana State University co-developed, implemented, and evaluated a CI self-management program for community members. This article examines qualitative and quantitative program impacts using a pragmatic cluster randomized clinical trial design with intervention and waitlist control arms. The quantitative and qualitative data resulted in different stories on the impact of the Báa nnilah program. Neither of the quantitative hypotheses were supported with one exception. The qualitative data showed substantial positive outcomes across multiple areas. We examine why the data sets led to two very different stories, and provide study strengths and limitations, recommendations, and future directions.
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Affiliation(s)
- Suzanne Held
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | - Du Feng
- Department of Nursing, University of Nevada, Las Vegas, NV 89154, USA;
| | - Alma McCormick
- Messengers for Health, Crow Agency, MT 59022, USA; (A.M.); (L.O.M.)
| | - Mark Schure
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | | | - John Hallett
- Petaluma Health Center, Petaluma, CA 94954, USA;
| | - Jillian Inouye
- Manoa School of Nursing, University of Hawaii, Honolulu, HI 96822, USA;
| | - Sarah Allen
- Department of Family Life & Human Development, Southern Utah University, Cedar City, UT 84720, USA;
| | - Shannon Holder
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | - Brianna Bull Shows
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | - Coleen Trottier
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | - Alexi Kyro
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
| | - Samantha Kropp
- Department of Human Development & Community Health, Montana State University, Bozeman, MT 59717, USA; (M.S.); (S.H.); (B.B.S.); (C.T.); (A.K.); (S.K.)
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Gonuguntla K, Sattar Y, Iqbal K, Sharma A, Yadav R, Alharbi A, Chobufo MD, Naeem M, Shaik A, Balla S. Trends in Premature Mortality from Acute Myocardial Infarction in American Indians/Alaska Natives in the United States from 1999 to 2020. Am J Cardiol 2024; 213:72-75. [PMID: 38110025 DOI: 10.1016/j.amjcard.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
Cardiovascular disease is the leading cause of mortality in American Indian and Alaska Native (AI/AN) groups. They are disproportionately found to have a higher rate of premature myocardial infarction (MI). The Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research were queried to identify premature MI deaths (female <65 years and male <55 years) occurring within the United States between 1999 and 2020. We investigated proportionate mortality trends related to premature MI in AI/ANs stratified by gender. Deaths attributed to acute MI (AMI) were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes I21 to I22. We compared the proportional mortality rate because of premature MI with that of a non-AI/AN racial group, which comprised all other races (Blacks, Whites, and Asian/Pacific Islander populations). In AI/ANs, we analyzed a total of 14,055 AMI deaths, of which 3,211 were premature MI deaths corresponding to a proportionate mortality rate of 22.8% (male 20.8%, female 26.2%). The non-AI/AN population had a lower proportionate mortality of 14.8% (male 13.7%, female 16%), p <0.01). On trend analysis, there was no significant improvement over time in the proportionate mortality of AI/ANs (19.8% in 1999 to 21.7% in 2020, p = 0.09). Upon comparison of gender, proportionate mortality of premature MI in women showed a statistically nonsignificant increase from 21.6% in 1999 to 27.3% in 2020 [average annual percent change of 0.7, p = 0.06)]. However, men had a statistically significant decrease in proportionate mortality of premature MI from 18.5% in 1999 to 18.2% in 2020 [average annual percent change of -0.8, p = 0.01)]. AI/ANs have an alarmingly higher rate of proportionate mortality of premature MI than that of other races, with no improvement in the proportionate mortality rates over 20 years, despite an overall downtrend in AMI mortality. Further research to address the reasons for the lack of improvement in premature MI is needed to improve outcomes in this patient population.
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Affiliation(s)
- Karthik Gonuguntla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aakanksha Sharma
- Department of Internal Medicine, Icahn School of Medicine, New York City, New York
| | - Ritu Yadav
- Midwestern University Graduate Medical Education Consortium/Verde Valley Medical Center, Cottonwood, Arizona
| | - Anas Alharbi
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Muchi Ditah Chobufo
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Minahil Naeem
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ayesha Shaik
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia.
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Miao G, Pechlaner R, Fiehn O, Malloy KM, Zhang Y, Umans JG, Mayr M, Willeit J, Kiechl S, Zhao J. Longitudinal Lipidomic Signature of Coronary Heart Disease in American Indian People. J Am Heart Assoc 2024; 13:e031825. [PMID: 38293910 DOI: 10.1161/jaha.123.031825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Dyslipidemia is an independent risk factor for coronary heart disease (CHD). Standard lipid panel cannot capture the complexity of the blood lipidome (ie, all molecular lipids in the blood). To date, very few large-scale epidemiological studies have assessed the full spectrum of the blood lipidome on risk of CHD, especially in a longitudinal setting. METHODS AND RESULTS Using an untargeted liquid chromatography-mass spectrometry, we repeatedly measured 1542 lipid species from 1835 unique American Indian participants who attended 2 clinical visits (≈5.5 years apart) and followed up to 17.8 years in the Strong Heart Family Study (SHFS). We first identified baseline lipid species associated with risk of CHD, followed by replication in a European population. The model adjusted for age, sex, body mass index, smoking, hypertension, diabetes, low-density lipoprotein cholesterol, estimated glomerular filtration rate, education, and physical activity at baseline. We then examined the longitudinal association between changes in lipid species and changes in cardiovascular risk factors during follow-up. Multiple testing was controlled by the false discovery rate. We found that baseline levels of multiple lipid species (eg, phosphatidylcholines, phosphatidylethanolamines, and ceramides) were associated with the risk of CHD and improved the prediction accuracy over conventional risk factors in American Indian people. Some identified lipids in American Indian people were replicated in European people. Longitudinal changes in multiple lipid species (eg, acylcarnitines, phosphatidylcholines, and triacylglycerols) were associated with changes in cardiovascular risk factors. CONCLUSIONS Baseline plasma lipids and their longitudinal changes over time are associated with risk of CHD. These findings provide novel insights into the role of dyslipidemia in CHD.
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Affiliation(s)
- Guanhong Miao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine University of Florida Gainesville FL
- Center for Genetic Epidemiology and Bioinformatics University of Florida Gainesville FL
| | - Raimund Pechlaner
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - Oliver Fiehn
- West Coast Metabolomics Center University of California Davis CA
| | - Kimberly M Malloy
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Ying Zhang
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | | | - Manuel Mayr
- National Heart & Lung Institute Imperial College London UK
| | - Johann Willeit
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - Stefan Kiechl
- Department of Neurology Medical University Innsbruck Innsbruck Austria
- Research Centre on Vascular Ageing and Stroke Innsbruck Austria
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine University of Florida Gainesville FL
- Center for Genetic Epidemiology and Bioinformatics University of Florida Gainesville FL
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Morral AR, Smart R, Schell TL, Vegetabile B, Thomas E. Geographic and Demographic Differences in the Proportion of Individuals Living in Households With a Firearm, 1990-2018. JAMA Netw Open 2024; 7:e240562. [PMID: 38416496 PMCID: PMC10902733 DOI: 10.1001/jamanetworkopen.2024.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/26/2023] [Indexed: 02/29/2024] Open
Abstract
Importance Measures of the proportion of individuals living in households with a firearm (HFR), over time, across states, and by demographic groups are needed to evaluate disparities in firearm violence and the effects of firearm policies. Objective To estimate HFR across states, years, and demographic groups in the US. Design, Setting, and Participants In this survey study, substate HFR totals from 1990 to 2018 were estimated using bayesian multilevel regression with poststratification to analyze survey data on HFR from the Behavioral Risk Factor Surveillance System and the General Social Survey. HFR was estimated for 16 substate demographic groups defined by gender, race, marital status, and urbanicity in each state and year. Exposures Survey responses indicating household firearm ownership were analyzed and compared with a common proxy for firearm ownership, the fraction of suicides completed with a firearm (FSS). Main Outcome and Measure HFR, FSS, and their correlations and differences. Results Among US adults in 2018, HFR was significantly higher among married, nonurban, non-Hispanic White and American Indian male individuals (65.0%; 95% credible interval [CI], 61.5%-68.7%) compared with their unmarried, urban, female counterparts from other racial and ethnic groups (7.3%; 95% CIs, 6.0%-9.2%). Marginal HFR rates for larger demographic groups also revealed important differences, with racial minority groups and urban dwellers having less than half the HFR of either White and American Indian (39.5%; 95% CI, 37.4%-42.9% vs 17.2%; 95% CI, 15.5%-19.9%) or nonurban populations (46.0%; 95% CI, 43.8%-49.5% vs 23.1%; 95% CI, 21.3%-26.2%). Population growth among groups less likely to own firearms, rather than changes in ownership within demographic groups, explains 30% of the 7 percentage point decline in HFR nationally from 1990 to 2018. Comparing HFR estimates with FSS revealed the expected high overall correlation across states (r = 0.84), but scaled FSS differed from HFR by as many as 20 percentage points for some states and demographic groups. Conclusions and Relevance This survey study of HFR providing detailed, publicly available HFR estimates highlights key disparities among individuals in households with firearms across states and demographic groups; it also identifies potential biases in the use of FSS as a proxy for firearm ownership rates. These findings are essential for researchers, policymakers, and public health experts looking to address geographic and demographic disparities in firearm violence.
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Affiliation(s)
| | | | | | | | - Emma Thomas
- Contributions completed while at RAND Corporation
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Llaneza AJ, Seward J, Holt A, Stephens LD. Oral Health Workforce and American Indian and Alaska Native Communities: a Systematic Review. J Racial Ethn Health Disparities 2024; 11:248-254. [PMID: 36692659 PMCID: PMC10781823 DOI: 10.1007/s40615-023-01515-7] [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] [Received: 09/16/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Understanding the oral health workforce representing and serving American Indian and Alaska Native (AI/AN) communities is vital to improving community dental health outcomes. No systematic review of recent published literature on the oral health workforce among this population has been completed. METHODS We conducted a systematic review of published literature examining the oral health workforce representing and serving AI/AN communities in the USA. We analyzed 12 articles according to the PRISMA Statement. RESULTS The studies suggested that AI/AN identity is an important aspect of routine and accessible oral healthcare. There are unique barriers and motivations that personnel in the oral health workforce face, let alone the distinctiveness of serving AI/AN communities. CONCLUSIONS This review provides evidence that expanded oral health positions aid in community members receiving more routine and preventative care and is an upstream public health approach that has diversified the dental workforce.
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Affiliation(s)
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK, USA
| | - Lancer D Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Townsend JS, Melkonian SC, Jim MA, Holman DM, Buffalo M, Julian AK. Melanoma Incidence Rates Among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019. JAMA Dermatol 2024; 160:148-155. [PMID: 38150212 PMCID: PMC10753438 DOI: 10.1001/jamadermatol.2023.5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/29/2023] [Indexed: 12/28/2023]
Abstract
Importance Non-Hispanic American Indian/Alaska Native people have the second highest incidence rate of invasive cutaneous melanoma in the US after non-Hispanic White people. Objective To examine invasive cutaneous melanoma incidence rates and trends over time among non-Hispanic American Indian/Alaska Native people. Design, Setting, and Participants This descriptive, observational cross-sectional study used population-based cancer registry data (US Cancer Statistics AI/AN Incidence Analytic Database) linked to the Indian Health Service administrative database to examine incidence rates by age, sex, region, histology, tumor site, stage, and other demographic and clinical characteristics. The study examined trends from 1999 to 2019 time period by age, sex, stage at diagnosis, and region. Non-Hispanic American Indian/Alaska Native people 15 years and older who received a diagnosis of invasive cutaneous melanoma from 1999 to 2019 who were members of federally recognized tribes and resided in Indian Health Service purchased/referred care delivery areas were included in this study to reduce racial misclassification and provide more accurate rates. The data were analyzed in 2022. Exposures Demographic and clinical characteristics, such as age, sex, geographic region, histology, stage, and tumor site. Main Outcomes and Measures Invasive cutaneous melanoma incidence rates by age group, sex, region, resident county characteristics (poverty level, rurality, education level, and socioeconomic status), stage at diagnosis, tumor site, and histology. Trends over time by age, sex, region, and stage. Results From 1999 to 2019, 2151 non-Hispanic American Indian/Alaska Native people (1021 female individuals [47.5%]) received a diagnosis of incident cutaneous melanoma (rate, 10.7 per 100 000; 95% CI, 10.3-11.2). Rates were higher among male than female individuals (13.0 [95% CI, 12.2-13.8] vs 9.2 [95% CI, 8.6-9.8]) and for people 55 years and older (24.2; 95% CI, 22.8-25.7) compared with those aged 15 to 39 years (3.5; 95% CI, 3.2-3.9). Rates were highest for male individuals 55 years and older (34.5; 95% CI, 31.8-37.3) and people living in the Southern Plains (male individuals: 23.8; 95% CI, 21.5-26.2; female individuals: 15.5; 95% CI, 14.0-17.2) and Pacific Coast region (male individuals: 16.5; 95% CI, 14.5-18.7; female individuals: 12.3; 95% CI, 10.9-13.9). Rates increased among female individuals from 1999 to 2019 (average annual percent change [AAPC], 2.5; P < .001); among regional/distant stage tumors (AAPC, 2.5; P = .01) and people 55 years and older (AAPC, 2.8; P = .001). Conclusions and Relevance The results of this study suggest that additional studies could potentially identify risk factors among non-Hispanic American Indian/Alaska Native people.
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Affiliation(s)
- Julie S. Townsend
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Stephanie C. Melkonian
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Dawn M. Holman
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Chamblee, Georgia
| | | | - Anne K. Julian
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Chamblee, Georgia
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De La Sablonnière-Griffin M, Collin-Vézina D, Esposito T, Dion J. Recurrent child protection post-investigation services for First Nations children in the province of Quebec. Child Abuse Negl 2024; 148:106243. [PMID: 37258368 DOI: 10.1016/j.chiabu.2023.106243] [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: 11/30/2022] [Revised: 03/12/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND The longitudinal trajectory of Indigenous children within child protection (CP) services, including their recurrent involvement, has yet to be documented. OBJECTIVES 1) To document whether First Nations children were at increased risk of a first recurrence of post-investigation CP services compared to children from the majority group. 2) To identify the characteristics associated with recurrence for First Nations children, and to compare these results to those for children from the majority group. METHOD Anonymized CP administrative data (2002-2014; n = 1150) of a region in the province of Quebec were used to conduct Cox proportional hazards modeling, in partnership with an advisory committee. RESULTS The risk of recurrence of First Nations children did not significantly differ from the risk for children from the majority group (HR: 0.980, n.s.) while controlling for covariates. Among First Nations children (n = 459), being under two at the case closure (HR: 2.718, p < .05), having received short-term intervention (HR: 5.027, p < .001) and coming from a family already known to the CP agency (HR: 2.023, p < .001) were associated with an increased risk of recurrence. CONCLUSIONS The findings highlight the importance of studying First Nations children's trajectories within CP services as a group deserving full attention and for First Nations to be able to design or demand appropriate services responding to their population's needs. A family-based research perspective is recommended to understand better the full family history leading to and in relation to CP services, which could provide more sound practice recommendations.
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Affiliation(s)
- Mireille De La Sablonnière-Griffin
- INRS-UQAT Joint Research Unit in Indigenous Studies, Urbanisation Culture Société Research Centre, Institut national de la recherche scientifique, Val-d'Or, Quebec, Canada.
| | | | - Tonino Esposito
- Canada Research Chair in Social Services for Vulnerable Children, School of Social Work, Université de Montréal, Montreal, Quebec, Canada.
| | - Jacinthe Dion
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Quebec, Canada.
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Springer YP, Filardo TD, Woodruff RS, Self JL. Racial and Ethnic Disaggregation of Tuberculosis Incidence and Risk Factors Among American Indian and Alaska Native Persons-United States, 2001-2020. Am J Public Health 2024; 114:226-236. [PMID: 38335486 PMCID: PMC10862211 DOI: 10.2105/ajph.2023.307498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Objectives. To examine impacts of racial and ethnic disaggregation on the characterization of tuberculosis (TB) epidemiology among American Indian and Alaska Native (AI/AN) persons in the United States. Methods. Using data reported to the National Tuberculosis Surveillance System during 2001 to 2020, we compared annual age-adjusted TB incidence and the frequency of TB risk factors among 3 AI/AN analytic groups: non-Hispanic AI/AN alone persons, multiracial/Hispanic AI/AN persons, and all AI/AN persons (aggregate of the first 2 groups). Results. During 2009 to 2020, annual TB incidence (cases per 100 000 persons) among non-Hispanic AI/AN alone persons (range = 3.87-8.56) was on average 1.9 times higher than among all AI/AN persons (range = 1.89-4.70). Compared with non-Hispanic AI/AN alone patients with TB, multiracial/Hispanic AI/AN patients were significantly more likely to be HIV positive (prevalence ratio [PR] = 2.05) and to have been diagnosed while a resident of a correctional facility (PR = 1.71), and significantly less likely to have experienced homelessness (PR = 0.53) or died during TB treatment (PR = 0.47). Conclusions. Racial and ethnic disaggregation revealed significant differences in TB epidemiology among AI/AN analytic groups. Exclusion of multiracial/Hispanic AI/AN persons from AI/AN analytic groups can substantively affect estimates of racial and ethnic health disparities. (Am J Public Health. 2024;114(2):226-236. https://doi.org/10.2105/AJPH.2023.307498).
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Affiliation(s)
- Yuri P Springer
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Thomas D Filardo
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Rachel S Woodruff
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Julie L Self
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
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Le VT, Bailey JA, Pandika DM, Epstein M, Satchell K. Long-term Effects of the Raising Healthy Children Intervention on Family Functioning in Adulthood: A Nonrandomized Controlled Trial. J Prev (2022) 2024; 45:17-25. [PMID: 37973659 PMCID: PMC10872592 DOI: 10.1007/s10935-023-00753-z] [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: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Some universal prevention programs, such as Raising Healthy Children (RHC), have shown persisting and wide-ranging benefits in adulthood, long after the intervention has ended. Recent studies suggest that benefits may continue into the next generation as well. This study examines whether the RHC intervention, delivered in childhood, may promote healthy family functioning among participants who now have families of their own. Participants were drawn from the Seattle Social Development Project (SSDP), a nonrandomized controlled trial of the RHC intervention prospectively following youths from 18 elementary schools in Seattle, Washington from 1985 to 2014. Participants who became parents were enrolled in an intergenerational study, along with their oldest biological child and an additional caregiver who shared responsibility for raising the child. Ten waves of data were collected between 2002 and 2018. The present analysis includes 298 SSDP parents, 258 caregivers who identified as a parent or partner of SSDP parent ("co-parent"), and 231 offspring. The SSDP parent sample was composed of 41.6% male, 21.1% Asian or Pacific Islander, 24.2% Black or African American, 6.4% Native American, and 48.3% white individuals. No significant intervention effects were found on adult romantic relationship quality; offspring bonding to co-parent; or co-parent past-month use of cannabis, cigarettes, or binge drinking. Findings highlight the continued need to understand how the benefits of theory-guided universal preventive interventions are sustained across the life course and how they may or may not shape family functioning for those who go on to have families and children of their own.ClinicalTrials.gov Identifier: NCT04075019.
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Affiliation(s)
- Vi T Le
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA.
| | - Jennifer A Bailey
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Danielle M Pandika
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Marina Epstein
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - Karryn Satchell
- Social Development Research Group, School of Social Work, University of Washington, Seattle, WA, USA
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