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PubMed2000

Mental health services for American Indians and Alaska Natives: need, use, and barriers to effective care.

This special review summarizes and illustrates the state of our knowledge regarding the mental health needs of American Indians and Alaska Natives. These needs are considerable and pervasive. The discussion begins by reflecting on the limits of psychiatric nomenclature and conceptual frameworks for revealing Native constructions of mental health and mental illness. The experience and manifestation of psychopathology can be both different and the same across cultures, hinging upon the extent to which such basic assumptions as the relationship of mind to body--and spirit in the case of Native people--or the primacy of the individual or social collective are shared. Having set the stage, this paper moves to recent empirical evidence regarding the mental health needs of American Indians and Alaska Natives: we review that evidence and consider it within the broader context of available services. The report closes with a brief overview of the most pressing issues and forces for change afoot in Indian country in the US. Most have to do with the structure and financing of care as tribes and other Native community-based organizations seek to balance self-determination and resource management to arrive at effective, fiscally responsible, culturally informed prevention, treatment, and aftercare options for their members. These changes may herald similar trends among First Nations people to the immediate north.

Adult↗
PubMed1996

Personality styles and dynamics of Alaska Native and nonnative incarcerated men.

The Rorschach and Million Clinical Multiaxial Inventory-II (MCMI-II) were used to examine personality styles and dynamics of 73 incarcerated Alaska Native and nonnative men. There were clear differences between native and nonnative inmates on both the MCMI-II and the Rorschach. Also, when the participants were separated into bicultural, assimilated, and traditional groups, the bicultural group had the most difficulties in coping and in interpersonal relationships. The results of this study suggest that the profile for offenders is not the same for Alaska natives and nonnatives. Culture and cultural styles may contribute to create a significantly different type of "criminal personality" seen in forensic settings.

Acculturation↗
PubMed1996

Substance use, mental health, and health in Alaska: emphasis on Alaska Native peoples.

It has always been a problem in Alaska to obtain a compilation of accurate and current data with regard to mental health, health, and substance abuse. This paper was designed to pull together different sources of data to present a comprehensive perspective on the substance use, mental health, and health problems facing Alaskans today. The article summarizes the most current substance abuse, mental health, and health data available for the State of Alaska from public, academic, and institutional sources. It emphasizes data relevant to Alaska Native groups, calling for improved efforts in the future to collect data according to ethnicity and gender. The data presented identify a number of significant substance use and mental health problems that are prevalent in Alaska, providing geographic and ethnic data wherever available.

Adolescent↗
PubMed1996

American Indian and Alaska native aboriginal use of alcohol in the United States.

Alcohol beverages prior to White contact originated with the Mayan and the Aztec Nations and spread to the American Indians of the Southwest. Surprisingly, there are a number of accounts of alcohol use among other American Indians and Alaska Natives. Beverages were limited to wine and beer, and included: balche, pulque, and "haren a pitahaya" wines, tulpi beer and other beverages. White contact brought dramatic shifts in the use and function of alcoholic beverages in American Indian and Alaska Native societies.

Alaska↗
PubMed1999

Hepatocellular carcinoma not related to hepatitis B virus infection among Alaska natives.

Chronic infection with hepatitis B or C viruses is a common underlying condition in patients with hepatocellular carcinoma worldwide. We studied serum and liver tissue from a cohort of Alaska natives with hepatocellular carcinoma (HCC) for evidence of hepatitis B, C and G viral infection using conventional serological tests as well as the sensitive polymerase chain reaction. Evidence of HBV infection was found in 25 and possible HCV infection in two cases. Among the remaining 11 patients, four had a history of recent or remote alcoholism while seven had no recognizable risk factors for HCC. Only one was seropositive for HGV RNA and that was an individual with a history of alcoholism. Non-tumorous liver tissue was available for study in six of these seven cases. Histological features of chronic hepatitis were present in five. Thus, at least five of 38 (13%) Alaska natives with HCC appeared to have chronic hepatitis not related to HBV or HCV infection, suggesting the possibility of some form of previously unrecognized chronic liver disease predisposing to HCC.

Adolescent↗
PubMed1996

Diabetes prevention in American Indians and Alaska Natives: where are we in 1994?

American Indians and Alaska Natives have experienced rapidly increasing rates of non-insulin-dependent diabetes (NIDDM). To address this epidemic Indian Health Service (IHS) and tribal communities have developed primary, second and tertiary intervention strategies. The scientific basis for secondary and tertiary prevention supports well-defined care practices, and the surveillance of the implementation of these practices and their impact on metabolic and hypertension control is now standard. Community interventions for the primary prevention of diabetes are underway and reflect the priorities of individual communities.

Alaska↗
PubMed2006

Redeeming hollow promises: the case for mandatory spending on health care for American Indians and Alaska Natives.

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need.

Budgets↗
PubMedDate not supplied

Nutritional rickets among breast-fed black and Alaska Native children.

Although nutritional rickets remains a problem primarily in developing countries, children in northern climates in developed countries may also be at risk. We reviewed the case histories of five children diagnosed in Alaska during 1993-96. Three of the children were black and two Alaska Native. Their ages ranged from 11 to 20 months and they presented during January, April, and September. All of the children were breast-fed but only two received their milk intake exclusively from breast milk. The presenting complaint included abnormal gait in two children and seizures, bowed legs, and growth delay in one child each. All five children demonstrated a decrease in their height-for-age percentile. The most common physical finding was a rachitic rosary which was present in four children. In Alaska, all black and Alaska Native children (and other more pigmented children) less than two years of age who receive all or part of their milk intake from breast milk should receive vitamin D supplementation regardless of the time of year.

Black or African American↗
PubMed2001

Community well being and infectious diseases among Alaska Native communities in the Chugach Region.

OBJECTIVES: This study sought to examine how Native people of the Chugach Region of Alaska perceive their own communities' health and well being, particularly in regard to infectious diseases. STUDY DESIGN: Prospective focus group interview survey. METHODS: During September to December 1999, 12 focus groups were conducted in seven communities in the Chugach Region of Alaska with 97 participants. Using a set of eight questions, information gathered provided insights into the participants' health-related perceptions and provided previously nonexistent baseline data pertaining toTB and hepatitis. RESULTS: Participants showed a good working knowledge of common infectious diseases. There were misconceptions and a potential for increased knowledge in highly prevalent diseases, but more recently delineated infections in rural Alaska, e.g., respiratory syncvtial virus (RSV), Helicobacter pylori, and less prevalent diseases, e.g., Acquired Immunodeficiency Syndrome (AIDS). The participants expressed a desire for further infectious disease information and dialogue. CONCLUSIONS: This process can be used to develop a risk assessment tool for medical and clinical providers' use in an effort to increase testing for such infectious diseases as HIV, TB, Hepatitis C, and sexually transmitted diseases (STDs). In this case the authors also produced a STD prevention video for rural Alaska Natives, entitled, Summer Sun Winter Moon.

Adolescent↗
PubMed2003

Cancer mortality among American Indians and Alaska Natives--United States, 1994-1998.

In the United States, public health interventions to control infectious diseases, lower infant and maternal mortality, and improve basic sanitation have led to a substantial increase in life expectancy for American Indians and Alaska Natives (AI/ANs). During 1940-1995, average life expectancy among AI/ANs increased 39%, from 51 years in 1940 to 71 years in 1995; however, AI/ANs experienced a parallel increase in mortality rates for chronic diseases, including cancer, which is the second leading cause of death for AI/ANs nationally and the leading cause of death among Alaska Natives. A previous study examining cancer mortality rates during 1989-1993 documented lower cancer mortality rates for AI/ANs than for the overall U.S. population, with regional variation. To understand cancer mortality among AI/ANs subsequent to that period, the Indian Health Service (IHS) and CDC analyzed death certificate data provided by CDC's National Center for Health Statistics for deaths among AI/ANs in five U.S. geographic regions during 1994-1998. This report summarizes the results of that analysis, which indicate that cancer mortality rates among AI/ANs nationally were lower than cancer mortality rates for all U.S. racial/ethnic populations combined. Rates for AI/ANs varied by region, with the highest rates found in the Alaska and the Northern Plains regions. Plans or modifications for cancer prevention and treatment programs should account for regional variation, and programs to discourage smoking initiation, encourage tobacco cessation, and promote colorectal cancer screening among AI/ANs in the Alaska and the Northern Plains regions should be expanded.

Alaska↗
PubMed2026

Orofacial Cleft Disparities in American Indian and Alaska Native Populations: A Systematic Review and Meta-Analysis.

ObjectiveTo evaluate the prevalence, access to care, and health outcomes of orofacial clefts (OFCs) among American Indian and Alaska Native (AI/AN) populations through a systematic review and meta-analysis.DesignSystematic review and meta-analysis performed in accordance with PRISMA 2020 guidelines and registered with PROSPERO (CRD420251035364).SettingUS-based population registries, hospital databases, and institutional or community-level retrospective studies involving AI/AN populations.Patients and ParticipantsAI/AN individuals with OFCs compared with non-Hispanic White patients.InterventionsPrimary cleft lip and palate repair, secondary cleft-related procedures, and multidisciplinary cleft care.Main Outcome Measure(s)Prevalence of OFCs, timing of cleft surgery, discharge disposition, access to specialists, and qualitative determinants of disparities.ResultsEighteen studies including more than 1985 AI/AN patients were identified. Meta-analysis of 5 studies estimated a pooled OFC prevalence of 15 per 10 000 live births (95% confidence interval: 5-49), with substantial heterogeneity (I2 = 99.8%). Individual studies reported significantly higher OFC prevalence in AI/AN populations compared to non-Hispanic Whites (odds ratio range: 1.44-2.68). Geographic maldistribution of craniofacial-trained surgeons, increased odds of nonhome discharge, and delayed cleft palate repair were consistently observed barriers. Qualitative analyses highlighted structural inequities, perceived racism, and lack of culturally responsive care as major contributors to disparities.ConclusionsAI/AN populations face a disproportionately high burden of OFCs alongside structural barriers to timely, culturally competent care. Addressing these disparities requires community-engaged, multidisciplinary interventions that improve geographic access and integrate culturally responsive approaches to care.

Humans↗
PubMed1993

Atherosclerosis in Alaska Natives and non-natives.

Low mortality from coronary heart disease (CHD) among Eskimos has been attributed to less atherosclerosis in the coronary arteries because of a high dietary intake of omega-3 fatty acids. Other investigators attribute this low mortality to the fact that Eskimos have a high mortality from other causes before middle age, when CHD is common. However, most studies have been epidemiological, either by death-certificate review or risk-factor evaluation. We evaluated the extent of atherosclerotic lesions in the coronary arteries and aortas from Alaska Natives. Standardised comparisons between samples from 103 Native and 101 non-native residents show that the extent of raised lesions increases with age in both groups, but the prevalence of raised lesions in native specimens was consistently lower than in those from non-natives. This difference was statistically significant. The data suggest that the differences in CHD mortality between Alaska Natives and non-natives are, at least in part, the result of less atherosclerosis in natives.

Adolescent↗
PubMed2006

Hepatitis B virus genotypes in Alaska Native people with hepatocellular carcinoma: preponderance of genotype F.

BACKGROUND: The development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection has been associated with specific HBV genotypes and the presence of specific mutations. METHODS: From a cohort of Alaska Native people with chronic HBV infection, we genotyped 47 patients with HCC and 1129 patients without HCC, and we tested patients with HCC and control patients for mutations in the basal core promoter and precore regions. RESULTS: Genotype F was found in 68% of patients with HCC, versus 18% of those without HCC (P<.001). For patients with genotype F, the median age at diagnosis of HCC was lower than that for patients with other genotypes (22.5 vs. 60 years, respectively; P=.002). Overall, there were no significant differences in the number of basal core promoter and precore region mutations between patients with HCC and control patients. CONCLUSIONS: We found a significant association between genotype F and the development of HCC among Alaska Native people with chronic HBV infection but no significant association between HCC and basal core promoter or precore mutations in genotype F.

Adolescent↗
PubMed1992

Pneumococcal endocarditis in Alaska natives. A population-based experience, 1978 through 1990.

BACKGROUND: Streptococcus pneumoniae is an uncommon cause of infective endocarditis (IE). We studied the presentation, microbiologic characteristics, and outcome of nine cases of S pneumoniae IE during a 12 1/2-year period in a population of 75,000 indigenous Alaska Natives (ANs), who have documented high rates of invasive pneumococcal disease. METHODS: Fifty-six cases of IE occurred in ANs statewide during 1978 through 1990. Medical records of all nine confirmed cases of S pneumoniae IE were reviewed. Incidence rates for S pneumoniae IE and all IE were calculated. RESULTS: Alaska Natives experience S pneumoniae IE as a fulminant illness, with acute aortic valve insufficiency (100%) frequently requiring emergent valve replacement, S pneumoniae meningitis (56%), and death (33%). No patient with S pneumoniae IE had known preexisting heart disease, and the most common underlying disease was alcoholism (56%). Pneumonia was diagnosed and embolic complications were suspected in 33%. All five S pneumoniae isolates examined were penicillin sensitive and were of serotypes included in the pneumococcal vaccine. Pneumococcal IE accounted for 15.8% of all IE diagnosed in ANs. Age- and sex-adjusted incidence rates for IE of all causes and S pneumoniae IE were 8.5 and 1.5 per 10(5) persons per year, respectively. During 1986 through 1988, 4.3% of AN adults diagnosed with S pneumoniae bacteremia developed S pneumoniae IE. CONCLUSIONS: Pneumococcal endocarditis in all but one AN case required emergent valve replacement and had a 33% mortality. The annual incidence rate of S pneumoniae IE in this population was five to 37 times higher than contemporary rates elsewhere. Increased efforts to prevent pneumococcal disease in ANs appear warranted. Clinicians everywhere should anticipate the possible development of S pneumoniae IE in adult patients with pneumococcal sepsis, especially with meningitis, even with previous vaccination and prompt adequate antimicrobial therapy.

Age Factors↗
PubMedDate not supplied

A qualitative study of the importance and etiology of chronic respiratory disease in Alaska native children.

OBJECTIVES: To generate new hypotheses about factors that may contribute to chronic respiratory disease in Alaska Native children in rural Alaska. METHODS: Qualitative formative research with interviews of community members, village healthcare providers, and referral providers in the Yukon-Kuskokwim Delta Region of Alaska. RESULTS: The respondents identified chronic and acute respiratory illnesses as the most important serious child health problems of the region. They believed that chronic respiratory conditions, especially asthma, were increasing. The most frequently discussed potential contributing factors were smoke, dust, feeding practices, socioeconomic conditions, and mold. The intervention mentioned most frequently that would make the greatest impact was a more timely diagnosis of asthma. CONCLUSIONS: Reports of an increase in chronic respiratory problems are parallel with reports of increases in dust and mold in the communities. Further environmental quantitative research is necessary to confirm the importance of these factors. In addition, improved education for identification and treatment of asthma would appear to be beneficial.

Alaska↗
PubMed2005

Stigma of mental illness among American Indian and Alaska Native nations: historical and contemporary perspectives.

Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.

Alaska↗
PubMed1990

Response to hepatitis B vaccine in Alaska natives with chronic alcoholism compared with non-alcoholic control subjects.

PURPOSE: This study was designed to determine if (1) alcoholics have a higher prevalence of hepatitis B virus (HBV) serologic markers than do non-alcoholic controls and (2) if they respond to hepatitis B vaccination in a manner similar to that of non-alcoholic controls. PATIENTS AND METHODS: The study was designed as a case-control study, and 129 Alaska Natives were recruited. Alcoholics were recruited from inpatient wards, outpatient clinics, a soup kitchen serving the homeless, and several alcohol rehabilitation centers; control subjects were recruited primarily from among Alaska Native Hospital employees. A standardized questionnaire, the Alcohol Dependency Scale (ADS), was administered to all participants. Each participant was screened for hepatitis B serologic markers, had liver function studies performed, and was examined for evidence of liver disease. Participants seronegative for HBV markers received three doses of hepatitis B vaccine. Linear regression analysis was performed to compare the amount of alcohol intake and variables associated with liver disease with the response to hepatitis B vaccination and antibody levels achieved. Using an ADS score of greater than 13, 64 participants were classified as chronic alcoholics, and 60 were classified as controls. RESULTS: HBV seropositivity was found in 22 alcoholics (34.4%) and seven controls (11.7%). After adjusting for age and sex, this difference was significant (chi 2 MH = 6.57, df = 1; p = 0.012). Abnormal levels of liver transaminase occurred significantly more often in alcoholic participants than in control subjects (chi 2 MH = 4.91, df = 1; p = 0.026). Of 95 seronegative persons, 72 received three doses of hepatitis B plasma-derived vaccine. Alcoholic subjects and control subjects did not differ significantly in their response to vaccination. Only four alcoholics and two controls did not develop antibody to hepatitis B surface antigen (anti-HBs) after hepatitis B vaccination, and two alcoholics and three controls had anti-HBs levels less than 10 SRU by radioimmunoassay. Mean anti-HBs levels measured in milli-international units (mIU) for the 62 responders showed a decrease in the anti-HBs level with increasing age (p less than 0.001). There was no difference in the mean anti-HBs log10 mIU between alcoholics and controls younger than 45 years of age, but in persons greater than 45 years of age, alcoholics had a lower mean anti-HBs log10 mIU level than did controls; this difference, however, was not significant (p greater than 0.10). CONCLUSION: Chronic alcoholics have a higher prevalence of HBV seromarkers than do age-matched controls. Seronegative alcoholics, especially those under age 45, respond well to hepatitis B vaccination, and such vaccination should be considered in all chronic alcoholic persons.

Adult↗
PubMed2000

Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: a 16-year population-based study.

The benefits of screening hepatitis B surface antigen (HBsAg)-positive carriers for hepatocellular carcinoma (HCC) in terms of long-term survival have not been established. We conducted a prospective 16-year, population-based cohort study to determine the impact of screening for HCC in 1,487 HBsAg-positive Alaska native carriers with alpha-fetoprotein (AFP) determinations every 6 months. Men and nonpregnant women with an elevated AFP level were evaluated for the presence of HCC by ultrasound (US) examination. The long-term survival rate for patients whose HCC was detected by the screening program was compared with a historical control group of Alaska native patients with HCC from the same population who were clinically diagnosed with HCC between 1969 and October 1982, through a National Cancer Institute-sponsored Cancer Registry. Between October 1982 and December 1998, 26,752 AFP determinations in HBsAg carriers were performed. One or more AFP elevations were found in 61 men and 39 nonpregnant women. HCC was diagnosed in 32 patients (24 men and 8 women). HCC tumors less than 6 cm were found in 23 patients; 22 patients had resections, and 1 patient refused a resection. Compared with 12 patients with hepatitis B virus (HBV)-related HCC diagnosed from 1969 to October 1982, before this program, the 5- and 10-year survival rate for the 32 patients with HCC were 42% (P =.008) and 30% (P =.07), respectively. Five- and 10-year tumor-free survival rates for carriers who had a normal AFP level on initial screening and subsequently developed HCC were 29% (P =.004) and 24% (P =.024), respectively. Screening of HBsAg carriers with semiannual AFP was effective in detecting most HCC tumors at a resectable stage and significantly prolonged survival rates when compared with historical controls in this population.

Adolescent↗