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Springtime macronutrient intake of Alaska natives of the Bering Straits Region: the Alaska Siberia Project.

OBJECTIVES: The diet of Alaska Natives is a complicated mix of native and imported foods. Dietary intake, which may have changed considerably in the past several decades, has important implications for risk of chronic disease. The objective of this study was to add to the knowledge of dietary intake of Alaska Natives of the Bering Straits Region by describing the macronutrient intake of adults. STUDY DESIGN: Observational study of dietary intake. METHODS: A 24-hour dietary recall was administered among all consenting, non-pregnant residents of four villages, aged 25 years, or more. RESULTS: Data are presented for 209 men and 225 women, who represent 48% of eligible participants. Dietary intake was higher in proportion of energy from protein and lower in proportion of carbohydrate than non-Hispanic white Americans overall. Higher energy and protein intakes were reported for men. Comparisons were also made among Alaskan ethnic groups and previous Alaskan surveys. CONCLUSION: This study of diet among Alaska Natives demonstrates consistency with other recent work. Differences in diet from earlier 20th century observations, such as higher carbohydrate and lower protein intake, are consistent with documented acculturation in Alaska and other circumpolar regions.

Adult↗

Comparison of values of Alaska Native and non-Native alcoholics and counselors.

Values of 42 Alaska Native clients, 30 Alaska Native counselors, and 19 non-Native counselors at seven Indian Health Service inpatient alcoholism treatment programs in Alaska are compared. Using the Rokeach Value Survey, differences were revealed on six instrumental values and six terminal values. The primary value disparities were between the Alaska Native groups and non-Native counselors. Specifically, both Alaska Native groups placed greater importance on values that were other-focused while the non-Native counselors placed more importance on values that were self-focused. Minor differences were noted also between clients and both groups of counselors. Therapeutic implications of such values disparities are discussed as are possible avenues to remediate the problem.

Adolescent↗

Traditional and western healing practices for alcoholism in American Indians and Alaska Natives.

The American Indian and Alaska Native population is a culturally diverse population with a current census of 1,959,000. Prior to White contact, there was historically little use of alcoholic beverages except for American Indians in the Southwest. After White contact, use and misuse of alcohol escalated rapidly; however, the prevalence, patterns, and problems of drinking alcoholic beverages vary enormously even in tribes closely linked geographically. American Indians and Alaska Natives have preserved and revitalized a number of traditional healing practices and applied these to the treatment of alcohol-related problems. These healing practices include the following: nativistic movements, sacred dances, sweat lodges, talking circle, four circles, and cultural enhancement programs. Additionally, Western treatment approaches have been applied in the treatment of problems related to alcohol, such as medication for detoxification, disulfiram (Antabuse), Alcoholics Anonymous, and behavioral interventions. Several investigators have completed a small number of naturalistic follow-up studies, but no one has undertaken a randomized controlled trial looking at specific methods of alcohol treatment in American Indians or Alaska Natives. American Indian and Alaska Native communities have adapted and integrated both Traditional and Western approaches to fit their own unique sociocultural needs.

Adult↗

Building a community-based participatory research center to investigate obesity and diabetes in Alaska Natives.

The Center for Alaska Native Health Research (CANHR) is a community-based participatory research project aimed at understanding current risk factors for obesity, diabetes, and cardiovascular disease in Alaska Natives living in Southwest Alaska. We utilize a multidisciplinary approach that includes assessment of genetic, nutritional and behavioral risk factors and their interrelationships with one another in the overall development of disease. The design of the CANHR project involved community participation in the development, implementation and interpretation of research results. We have developed a participatory research program that is designed to be culturally appropriate, relevant to community needs and interests, and respectful to our participants. This manuscript describes the organizational development of our CANHR study and the procedures employed in its progression to date.

Alaska↗

Unheard Alaska: culturally anchored participatory action research on sobriety with Alaska Natives.

Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychology's understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation.

Alaska↗

Colorectal cancer incidence and survival among Alaska Natives, 1969-1993.

BACKGROUND: Although colorectal cancer rates are low among most groups of Native Americans in North America, rates for Alaska Natives have been substantially elevated compared with US rates for all races combined. METHODS: To better describe the epidemiology of colorectal cancer incidence and survival among Alaska Natives, stratified by gender and tribal/ethnic affiliation, we examined data collected by the Alaska Native Cancer Registry 1969-1993. We calculated age-adjusted and age-specific incidence as well as actuarial survival rates, and examined histological type, site, stage at diagnosis, and treatment. We compared these data to colorectal cancer data from whites living in western Washington. RESULTS: In all, 587 colorectal cancer cases were identified among Alaska Natives over the 25-year period, for an age-adjusted annual incidence rate of 71.4/100000 in women, and 69.3/100000 in men. Compared to Alaska Indians, colon cancer rates were significantly higher in Aleuts (relative risk [RR] = 1.6, 95% CI: 1.2-2.2) and in Eskimos (RR = 1.5, 95% CI: 1.2-1.8), while rectal cancer rates did not differ by race/ethnicity. Alaska Natives experienced a 50% higher incidence rate of colorectal cancer overall compared to western Washington whites (RR = 1.5, 95% CI: 1.3-1.6), although rectal cancer rates were similar in the two populations. The highest RR were seen among Alaska Native women; Aleuts and Eskimos had colon cancer rates more than twice that of western Washington white women. No unusual qualitative features were found in the cancers occurring in Alaska Natives. Actuarial colorectal cancer survival rates for Alaska Natives overall were 74% at one year and 42% at 5 years; these rates were very similar to those observed for the western Washington population. Both one and 5-year survival rates showed a significant trend towards improvement over time. CONCLUSIONS: Alaska Natives had substantially higher colorectal cancer incidence rates compared to western Washington whites. Rates were particularly high for Aleut and Eskimo women. These data suggest a need for intensified secondary prevention strategies for this high-risk population, while further research is needed to identify modifiable risk factors.

Actuarial Analysis↗

Comparison of atherosclerosis in alaska Natives and nonnatives.

OBJECTIVE: To test the hypothesis that Alaska Natives have fewer atherosclerotic lesions in the coronary arteries and aorta than nonnative Alaska residents. DESIGN: Systematic standardized collection and evaluation of coronary arteries and aortas collected at autopsy. SETTING: Forensic autopsy service in Alaska. SUBJECTS: One hundred thirty Alaska Natives and 115 Alaska nonnatives who underwent forensic autopsy between February 1989 and December 1993. INTERVENTION: None. MAIN OUTCOME MEASURES: Prevalence and extent of atherosclerotic lesions in the aortas and coronary arteries in both populations studied. RESULTS: Alaska Natives had significantly lower prevalence and extent of raised atherosclerotic lesions in the abdominal aorta and coronary arteries than nonnative Alaska residents. CONCLUSIONS: Differences in coronary heart disease mortality between Alaska Natives and nonnatives are, at least in part, the result of fewer atherosclerotic lesions in Alaska Natives.

Adolescent↗

Botulism among Alaska natives in the Bristol Bay area of southwest Alaska: a survey of knowledge, attitudes, and practices related to fermented foods known to cause botulism.

OBJECTIVES: Botulism cases due to traditional Alaska Native fermented foods occur periodically in Southwest Alaska. In this population, we conducted a survey on knowledge, attitudes, and practices related to botulism and fermented foods. METHODS: We interviewed 140 adults randomly chosen from nine villages. Data collected included fermented food consumption frequency; knowledge about the cause and symptoms of botulism; and fermented food preparation methods. RESULTS: Most respondents (81%) had eaten Alaska Native fermented foods at least once. Over 70% identified botulism as a foodborne illness, and over 87% believed eating certain Native fermented foods could cause botulism. One-third of fermented food preparers used plastic containers for fermentation. To prevent botulism, 45% vwould consider boiling fermented foods, and 65% would not eat foods fermented in plastic or glass containers. CONCLUSIONS: Despite high awareness of botulism in this population, one-third of fermented food preparers use plastic containers, a practice which may increase the risk of botulism. Misconceptions and acceptable prevention messages about botulism, such as using traditional nonplastic fermentation methods, were identified and included in an educational video.

Adolescent↗

A comparison of the diets of Siberian Chukotka and Alaska Native adults and recommendations for improved nutrition, a survey of selected previous studies.

Diet plays an important role in the development of common diseases among Northern indigenous people, i.e. heart disease, cancer, diabetes and iron deficiency. Their unique diets may contribute to or protect from these diseases. The diets consumed by Siberian Chukotka Natives (Russia) and Alaska Natives (United States) during the 1980's are described. Traditional foods still play a major role, although the extent of their use varies. Alaska Natives' diets are more "western" than are those of Chukotka Natives. They consumed a greater proportion of kilocalories as carbohydrates and fat than Chukotka Natives. Coastal Chukotka Natives had lower average serum LDL-cholesterol and higher HDL-cholesterol levels than tundra Chukotka Natives, despite their high fat and kilocalorie intakes. Dietary recommendations common to both groups are presented which encourage the use of traditional foods as the foundation of the diet supplemented with western type foods of appropriate quality and quantity.

Adult↗

Cancer incidence in Alaska Natives thirty-year report 1969-1998.

The Alaska Native Tumor Registry includes data from 1969 to the present. This report provides incidence rates over the thirty year period, 1969 through 1998, and compares trends over time for Alaska Natives (AN) with those of US Whites and Blacks. To examine current rates, average annual age-adjusted incidence rates for AN for 1984-98 are compared with US Whites. Data from the registry document numerous differences in rates of occurrence of specific cancers compared to US Whites and Blacks. Studies of these differences may provide clues to the causes and risk factors for the cancers. Most importantly, these data show that although cancer was considered a rare disease in the Alaska Native population as recently as the mid-twentieth century, the incidence rate for all cancers combined among Alaska Natives is now as high as that of US Whites, and even higher in women. On the other hand, despite relative differences in rates, the most frequently diagnosed cancers among Alaska Natives are the same as US Whites. Cancers of the lung, colon/rectum, breast, and prostate are most frequently diagnosed among Alaska Natives and in the U.S. These four cancers comprise over 50% of all diagnosed invasive cancers. Cancer of the lung is almost entirely preventable by eradication of tobacco use. Screening and early detection have been proven to reduce mortality for cancers of the colon/rectum and breast. Primary and secondary prevention of these cancers could markedly improve morbidity and mortality.

Black or African American↗

Alaska Natives assessing the health of their environment.

The changes in Alaska's ecosystems caused by pollution, contaminants and global climate change are negatively impacting Alaska Natives and rural residents who rely on natural resources for food, culture and community identity. While Alaska commerce has contributed little to these global changes and impacts, Alaska and its resources are nonetheless affected by the changes. While Alaska Natives have historically relied on Alaska's land, water and animals for survival and cultural identity, today their faith in the safety and quality of these resources has decreased. Alaska Natives no longer believe that these wild resources are the best and many are turning to alternative store-bought foods. Such a change in diet and activity may be contributing to a decline in traditional activities and a decline in general health. Contaminants are showing up in the animals, fish and waters that Alaska Natives use. Efforts need to be expanded to empower Alaska Native Tribes to collect and analyze local wild foods for various contaminants. In addition existing information on contaminants and pollution should be made readily available to Alaska residents. Armed with this type of information Alaska Native residents will be better prepared to make informed decisions on using wild foods and materials.

Alaska↗

Health care delivery for Alaska Natives: a brief overview.

OBJECTIVES: Describe the Alaska Native Health Care delivery system and some of the historical elements that shaped it. STUDY DESIGN: Retrospective program review. METHODS: Retrospective review of existing administrative and clinical programs. RESULTS: Over the last 10,000-15,000 years the Alaska Native Health System developed from at traditional tribal based self-care system to a complex system that is interdependent on local, state, federal, and private insurance payers. The Alaska Tribal Health System takes an intentional approach to planning. While the system may face an uncertain future, it is poised to continue it remarkable success. The regional health corporations are the backbone of the system and it is the regional health corporations that own the Alaska Tribal Health System. In addition, it is the Alaska Tribal Health System that is responsive to the needs and priorities of the regional health corporations and their Native constituents. The spirit of the Alaska Native has inspired their health care providers at all levels to develop innovative "work arounds" to provide state of the art care through regionalization and telemedicine. Despite the many challenges ahead, the Alaska Tribal Health System will continue to strive to increase the health of Alaska Native people to the highest status possible. CONCLUSION: The Alaska Native health care system is a dynamic system administered by and for Alaska Native peoples. This system has risen to many challenges in the past and has made great strides through both ingenuity and necessity.

Alaska↗

The tools to understand: community as co-researcher on culture-specific protective factors for Alaska Natives.

A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test ameasure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described.

Adult↗

Prevalence of tobacco use among Alaska Natives: a review.

BACKGROUND: Previous reports documented high rates of tobacco use among Alaska Natives (Eskimos, Indians, and Aleuts). In this population, tobacco use is the leading preventable cause of death. Lung cancer is the leading cause of cancer death among Alaska Natives and tobacco is responsible for over one-third of all cancer deaths in this population. Until recently there has been no systematic surveillance of the prevalence of tobacco use in this high-risk population. Data that did exist were not readily available to those primarily responsible for the health care of this population. This is the first time since 1990 that data on Alaska Natives have been collected in one analysis; this permits a more representative evaluation of tobacco use. METHODS: Data on tobacco use were obtained and analyzed from national and state surveys and selected research projects from 1988 to 1993. RESULTS: Alaska Natives have high prevalence of tobacco use, including both cigarettes and smokeless tobacco. Tobacco use prevalence among Alaska Natives exceeds that of Alaska non-Natives, U.S. whites, and American Indians/Alaska Natives in the United States outside of Alaska. Smoking prevalence among Alaska Native women is twice that of non-Native women in Alaska and nearly twice as high among pregnant Alaska Natives than pregnant non-Natives. Overall, prevalence of smokeless tobacco use was four times higher among Alaska Natives than comparative state and national populations. CONCLUSION: Because this population has such high rates of tobacco use, it is important to public health that monitoring and educational programs be in place and that data specific to Alaska Natives be made available.

Alaska↗

Focus groups of Y-K Delta Alaska Natives: attitudes toward tobacco use and tobacco dependence interventions.

BACKGROUND: Tobacco dependence interventions developed for Alaska Natives are virtually nonexistent. Alaska Natives residing on the Yukon-Kuskokwim (Y--K) Delta in southwestern Alaska use a unique form of smokeless tobacco (ST) known as Iqmik. This study employed focus group methodology to explore attitudes toward tobacco use and tobacco dependence interventions among Alaska Natives residing on the Y-K Delta. METHODS: Twelve focus groups of former and current tobacco users were conducted in four villages in the Y-K Delta. Participants were 35 adults (83% female) and 22 adolescents (27% female). Participants completed a brief demographic and tobacco use history form. Statements from the focus groups were transcribed for content coding and analysis of the major themes. RESULTS: Use of Iqmik in the villages is thought to be ubiquitous. Y-K Delta Alaska Natives are introduced to Iqmik at a very young age. Iqmik is mostly used and prepared by young Alaska Natives and adult women. There are few perceived adverse health effects of Iqmik or other tobacco use. Although there is interest in stopping, there is a perceived lack of availability of tobacco dependence interventions. The major barriers to preventing the initiation of and stopping tobacco use are the social acceptance and widespread use and availability of tobacco. CONCLUSION: The attitudes toward tobacco and identified barriers to stopping will be useful in developing tobacco dependence interventions for Alaska Natives.

Adolescent↗

Haemophilus influenzae type b anticapsular antibody responses to PRP-pertussis and PRP-D vaccines in Alaska native infants.

To evaluate immune responses in Alaska Native infants at high risk for invasive Haemophilus influenzae type b (Hib) disease, we studied PRP-pertussis and PRP-D conjugate vaccines in this population relative to responses in white infants in California and New York. Infants were immunized at two, four, and six months of age (both vaccines). In the PRP-pertussis trial, there were no significant differences in antibody levels at any age between Alaska Native infants and infants from California. Only 50% of the infants had a twofold or greater antibody rise after three doses. In the PRP-D trial, antibody levels at two months of age (presumably maternally acquired) were significantly higher for Alaska Native infants compared with infants from New York (P = .002). There were no significant differences in antibody levels after any of the three doses. Among Alaska Native infants there was no significant difference in antibody response based upon degree of ethnic purity.

Alaska↗

Cancer mortality among Alaska natives, 1994-1998.

Although overall cancer mortality rates in the U.S. declined throughout the 1990s, Alaska Native rates increased. This study compares mortality patterns of Alaska Natives for the period, 1994-1998, and U.S. Whites, and examines changes in rates since 1960-1969. We used death certificate data and Indian Health Service population estimates to create age-adjusted mortality rates for Alaska Natives. We compared these rates to NCHS mortality for U.S. Whites. In all, 597 Alaska Natives died of cancer over the five-year period, 1994-1998, their age-adjusted average annual mortality rate (224.5 per 100,000) was thirty percent higher than that of U.S. Whites (166.7 per 100,000), a statistically significant excess (OR = 1.3, 95% CI: 1.2-1.4). Alaska Natives were forty percent more likely to die of lung cancer than U.S. Whites (OR = 1.4, 95% CI: 1.2-1.6). This population also demonstrated elevated mortality rates for several other smoking-related cancers. Also, Alaska Natives are at excess risk for nearly all cancers of the digestive system. Alaska Natives experienced the same or lower mortality rates for genitourinary cancers excluding cancer of the kidney. Smoking related cancers, and particularly, lung cancer, were the major contributors to the excess mortality rates. These data suggest that the burden of cancer on the Alaska Native healthcare system will continue to increase as the population ages. Intensified efforts to modify behavioral risk factors are needed.

Alaska↗

Unemployment, drug use, and HIV risk among American Indian and Alaska Native drug users.

American Indians and Alaska Natives have had low employment in recent history. Drug users also have low employment due to cycles of drug use and relapse,and the impact of the type of drug abused on levels of functioning. Drug use is associated with increased HIV risk through injection drug use, frequency of injection, and needle sharing. Data from three sites of the NIDA Cooperative Agreement for Community Based-Outreach/Intervention Research were analyzed to determine the relationship among race/ethnicity, age, and level of educational attainment on employment and unemployment at intake interview and six-month follow-up. HIV risk for those employed and unemployed was then assessed. American Indian and Alaska Native drug users were younger, less educated, and less likely to have a paid job at both intake and follow-up than non-Native drug users. Those participants who were unemployed at baseline interview who were American Indian/Alaska Native were less likely to transition to employment at six-month follow-up than other race/ethnicity groups in the cohort. However, all participants showed low levels of employment at follow-up. Individuals who were employed at baseline and those who transitioned to employment had lower levels of injection drug use and needle sharing than those who were unemployed at both baseline and follow-up. American Indian and Alaska Native drug users may be at risk for acquisition of HIV due to drug risk behaviors that appear to be associated with unemployment.

Adult↗