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PubMed1994

Cultural barriers to mental health care delivery in Alaska.

Geographically diverse providers from all mental health disciplines attended a recent conference in Anchorage and discussed cultural barriers to the delivery of mental health care in Alaska. Based on their knowledge, experience, and perceptions, this article describes barriers contributed by the mental health care delivery system as well as those contributed by the American Indian and Alaska Native cultures. American Indians and Alaska Natives are experiencing deculturation, outmigration, alienation, distrust, and despair. The difficulties at the interface between Alaskan mental health care providers and consumers indigenous to Alaska have implications for administrative and clinical endeavors in culturally diverse settings elsewhere. Progress in this area will require special administrative skills.

Alaska↗
PubMed2002

Native American women in alcohol and substance abuse treatment.

Alcohol and other drug use is a serious problem among American Indian and Alaska Native women. However, information about their needs for treatment is lacking. In response, a study was conducted to document the life experiences and perceived recovery needs of American Indian and Alaska Native women at nine treatment centers nationwide. The data show that most of these women have experienced various forms of abuse and neglect from childhood into adulthood and have been exposed to alcohol and other drugs from an early point in their lives. Most of these women have made multiple attempts to recover from their addictions, often for the sake of their children. The information derived from this study can be used as the foundation for further research about the treatment needs of American Indian and Alaska Native women.

Adolescent↗
PubMed1985

Molecular epidemiology of plasmid-mediated ampicillin resistance in Haemophilus influenzae type b isolates from Alaska.

Native Alaskans have a high incidence of disease caused by invasive Haemophilus influenzae type b and represent an isolated population for epidemiological study. We used plasmid DNA analysis and subtyping of outer membrane proteins as markers to characterize 29 ampicillin-resistant, invasive strains and seven ampicillin-resistant, noninvasive strains of this organism from distinct geographic regions. All 36 strains produced beta-lactamase; 34 strains transferred resistance by conjugation. Seven of the 36 strains harbored detectable plasmid DNA: four had a molecular mass of 40 MDa, and three had a molecular mass of 3 MDa. Furthermore, 20 transconjugants had a similar large plasmid, and four had a similar small plasmid. Ten of 12 transconjugants with either the large, small, or undetectable plasmid DNA were able to retransfer resistance. Transformation of resistance was successful with two large plasmids. DNA-DNA hybridization studies revealed that 33 of 36 strains had DNA homology. Restriction endonuclease digestion of 10 large plasmids revealed five patterns; identity was evident within a geographic region, and similarity existed between regions. Seven restricted plasmids demonstrated an identical pattern with a small beta-lactamase probe. Ampicillin resistance in these isolates from Alaska is primarily due to a common, 40-MDa conjugative plasmid that mediates beta-lactamase production, a finding which differs from that for ampicillin-resistant plasmids isolated elsewhere in the United States. Despite variable outer membrane protein profiles of the distinct strains of H. influenzae type b, the plasmids shared significant DNA homology. It appears that a common genetic element was responsible for the dissemination of this phenotype for resistance in Alaska.

Alaska↗
PubMed1997

Alcohol-related injury death and alcohol availability in remote Alaska.

CONTEXT: Injury is a major public health problem in Alaska, and alcohol consumption and injury death are associated. OBJECTIVE: To determine the association between injury death, particularly alcohol-related injury death, and alcohol availability in remote Alaska. DESIGN, SETTING, AND PARTICIPANTS: Survey using death certificate data and medical examiner records to compare mortality rates for total injury and alcohol-related injury during 1990 through 1993 among Alaskans aged 15 years and older who had resided in remote villages of fewer than 1000 persons. MAIN OUTCOME MEASURES: Rate ratios of injury death among residents of wet villages (ie, those without a restrictive alcohol law) as compared with injury death among residents of dry villages (ie, those with laws that prohibited the sale and importation of alcohol). RESULTS: Of 302 injury deaths, blood alcohol concentrations (BACs) were available for 200 deaths (66.2%). Of these, 130 (65.0%) had a BAC greater than or equal to 17 mmol/L (> or =80 mg/dL) and were, therefore, classified as alcohol related. The total injury mortality rate was greater among Alaska Natives from wet villages (rate ratio [RR],1.6; 95% confidence interval [CI], 1.3-2.1), whereas this difference was not present for nonnatives (RR, 1.1; 95% CI, 0.3-3.8). For Alaska Natives, the alcohol-related injury mortality rate was greater among residents of wet villages (RR, 2.7; 95% CI, 1.9-3.8) than among residents of dry villages. The strength of this association was greatest for deaths due to motor vehicle injury, homicide, and hypothermia. CONCLUSIONS: Although insufficient data existed to adjust for the effects of all potential confounders, residence in a wet village was associated with alcohol-related injury death among Alaska Native residents of remote Alaska villages. These findings indicate that measures limiting access to alcoholic beverages in this region may decrease alcohol-related injury deaths.

Accidents↗
PubMed1996

Clinical hypertension in Native Americans: a comparison of 1987 and 1992 rates from ambulatory care data.

THE AUTHORS EXAMINED THE PREVALENCE of clinically diagnosed hypertension among all American Indian and Alaska Native outpatients served in Indian Health Service (IHS) facilities in fiscal year 1992, and compared these rates with a similar analysis done in 1987. In this report they provided data on that analysis as well as on the association between hypertension and diabetes. The 1992 overall estimated age-adjusted prevalence of clinically diagnosed hypertension in adults older than age 15 was 10.4%, compared with 10.9% in 1987, a small but significant decrease. Considerable variation exists in hypertension prevalence rates in American Indian communities as analyzed by IHS service area. This report represents an attempt to use ambulatory patient care data to demonstrate a means for ongoing surveillance of a chronic disease for the entire service population of the IHS. This comprehensive data set represents approximately 60% of the entire U.S. American Indian and Alaska Native population. Based on the ongoing nature of this ambulatory patient care data system, this model for hypertension surveillance permits a unique opportunity for longitudinal evaluation of quality improvement efforts for the American Indian and Alaska Native populations served by the IHS.

Adolescent↗
PubMed1996

Overview of National Cancer Institute networks for cancer control research in Native American populations.

BACKGROUND: The National Cancer Institute established two Native American cancer control research networks. These networks were created to develop and promote a cadre of cancer prevention and control scientists to conduct culturally sensitive research among Native American populations (i.e., American Indian, Alaska Native, Native Hawaiian, and American Samoan). The primary objective of these research efforts is to reduce morbidity and mortality from cancer. Toward reaching this objective, the networks have (1) conducted research, (2) affiliated with or stimulated other groups to conduct research, or (3) facilitated research by encouraging the training of new researchers of Native American origin to promote prevention and early detection as well as state-of-the-art treatment among their people. METHODS: The networks are organized and financially supported by the NCI. Members of the network have established working committees that follow up on tasks identified during the meetings. RESULTS: Accomplishments of these networks have been recorded between 1990 and 1996. Two strategic plans for cancer control research among American Indians and Alaska Natives have been drafted and disseminated. One of the plans was designed for federal agencies and the other for state health departments. The networks have conducted three national surveys regarding native peoples' access to cancer prevention and control services and conducted two national Native American cancer conferences. The Native Hawaiian/American Samoan Task Force was established in 1992 due to the high incidence and mortality statistics for cancer in these populations. CONCLUSIONS: Through support mechanisms such as those implemented by the NCI, independent networks can be created to advocate actively for cancer prevention and control efforts within Native American communities, among nonnatives, and within professional organizations and governmental agencies.

American Samoa↗
PubMedDate not supplied

Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88.

Native Americans experienced higher reported gonorrhea and syphilis morbidity than did non-Native Americans from 1984 through 1988 in 13 States with large Native American populations. Gonorrhea rates among American Indians and Alaska Natives were approximately twice the rates for non-Indians. The highest gonorrhea rate was reported among Alaska Natives, with a 5-year average of 1,470 cases per 100,000, more than five times the average non-Native rate in Alaska. The average primary and secondary (P&S) syphilis rate from 1984 through 1988 was more than two times higher among Native Americans, largely due to high syphilis morbidity in Arizona and New Mexico. In Arizona the average American Indian P&S syphilis case rate was seven times higher than the non-Indian rate. True rates for sexually transmitted diseases (STD) among Native Americans may be higher than those reported due to racial misclassification of Native American cases, particularly in nonreservation areas. Improved recognition and reporting of STD cases among Native Americans are needed to target STD prevention and education more effectively.

Alaska↗
PubMed2001

Race-specific results of Papanicolaou testing and the rate of cervical neoplasia in the National Breast and Cervical Cancer Early Detection Program, 1991-1998 (United States).

OBJECTIVE: To describe differences in cervical screening and biopsy results by race or ethnicity from women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: We examined the percentage of abnormalities detected by Papanicolaou (Pap) tests and the rate of biopsy-diagnosed high-grade precancerous or cancerous lesions by racial or ethnic group. RESULTS: Almost half the 628,085 women screened were members of racial or ethnic minority groups. American Indian or Alaska Native women were more likely than others to report never having had a prior Pap test. American Indian or Alaska Native women had the highest proportion of abnormal Pap tests for first program screens (4.4%), followed by blacks (3.2%), whites (3.0%), Hispanics (2.7%), and Asians or Pacific Islanders (1.9%). Whites had the highest biopsy detection rate of high-grade lesions for first program screens (9.9 per 1000 Pap tests), followed by Hispanics (7.6), blacks (7.1), American Indians or Alaska Natives (6.7), and Asians or Pacific Islanders (5.4). CONCLUSIONS: This program provides important data on the prevalence of cervical neoplasia among diverse populations. Our findings that black women with a high-grade Pap test were less likely to get a work-up are disconcerting and merit further study and ultimate correction.

Adolescent↗
PubMed1999

Reemergence of invasive Haemophilus influenzae type b disease in a well-vaccinated population in remote Alaska.

Before vaccination, Alaska Natives experienced very high rates of invasive Haemophilus influenzae type b (Hib) disease and carriage. Vaccination with Hib conjugate vaccine PRP-OMP (polyribosylribitol phosphate Neisseria meningitidis outer membrane protein) began in 1991 and resulted in a sharp decline in cases. In 1996, after switching to a different Hib conjugate vaccine, DTP-HbOC (which combines diphtheria-tetanus-whole cell pertussis vaccines with HbOC [Hib oligosaccharide CRM197]), cases of invasive Hib disease increased, suggesting ongoing Hib transmission despite widespread vaccination. To determine the prevalence of and risk factors for carriage, a cross-sectional study of oropharyngeal Hib carriage was conducted among Alaska Native children aged 1-5 years in remote southwestern Alaska. Of 496 children with swabs taken, 46 (9.3%) were colonized with Hib. Carriage rates varied by village from 2.2% to 13.2% and by age from 6.1% in 1-year-olds to 14.7% in 5-year-olds. Crowding was associated with Hib carriage. Widespread vaccination with PRP-OMP Hib conjugate vaccine did not eliminate carriage in this population of Alaska Natives, and ongoing carriage contributed to disease resurgence.

Age Factors↗
PubMed2005

Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist.

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children. We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children. Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue-one of social justice.

Alaska↗
PubMed1988

Food-borne botulism in Alaska, 1947-1985: epidemiology and clinical findings.

We reviewed records of all food-borne outbreaks of botulism in Alaska from 1947 through 1985. Fifty-nine confirmed or suspected outbreaks with 156 cases were reported. All outbreaks occurred in Alaska Natives and were associated with eating traditional Alaska Native foods. Forty-four (75%) of the outbreaks were laboratory confirmed and involved 133 persons. The overall annual incidence of confirmed or suspected botulism was 8.6 cases per 100,000 population. Seventeen persons died, an overall case-fatality rate of 11%. Type E toxin accounted for 32 (73%) laboratory-confirmed outbreaks; type A, six (14%); and type B, five (11%). Forty-one cases demonstrated botulinal toxin in one or more specimens (serum, gastric contents, or stool). Of the 41 botulinal toxin-positive persons, 38 (93%) had at least three of the commonly recognized pentad of signs or symptoms--nausea and vomiting, dysphagia, diplopia, dilated and fixed pupils, or dry mouth and throat--and 20 (49%) required respiratory assistance.

Adolescent↗
PubMed1996

Native American Cancer Conference III. Cognitive correlates and impressions of attendees.

BACKGROUND: The results of preconference and postconference surveys, as well as conference evaluation forms, distributed to attendees at the "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies," Seattle, Washington, June 16-19, 1995, are presented. METHODS: Conference attendees were requested to complete a multi-item survey designed to assess knowledge and perceptions relating to cancer among native peoples at the beginning and end of the conference. The evaluation instrument solicited qualitative impressions of the conference. RESULTS: Survey respondents were predominantly female (70%), and approximately half were native persons representing 48 different American Indian and Alaska Native communities. Knowledge levels were generally high at baseline for most items relating to cancer, with evidence of significant improvement for several items on the postconference survey. The majority of respondents believed that cancer was of equal importance compared with other health problems and that cancer services for American Indians and Alaska Natives are generally less extensive compared with the majority population; there was no evidence of opinion change noted in the postconference survey. Results from the qualitative evaluation expressed the unique and affirmative experiences among participants in terms of the social, cultural, and informational sharing that occurred. CONCLUSIONS: It is hoped that the positive experiences of conference attendees will serve to stimulate the organization of similar programs and the design of research projects that both assess and expand cancer control services among Native peoples.

Adult↗
PubMedDate not supplied

Native women and cancer.

Literature regarding cancer patterns in American Indians and Alaska Native women is reviewed and attention is paid to promising research initiatives to improve cancer prevention and control as well as approaches to enhance exchange of knowledge through a new national resource center. Lung, breast, and colorectal cancer are the leading cause of cancer deaths in American Indians and Alaska Native women. There continues to be a disproportionate death rate from cervical cancer. Enhanced availability for breast and cervical cancer screening in conjunction with community education is showing promising trends toward reversing the patterns of late diagnosis. Communities can benefit from sharing their collective resources in a new national resource center called "Native C.I.R.C.L.E." housed in the Mayo Cancer Center.

Attitude to Health↗
PubMed1986

Nutrition in American Indian health: past, present, and future.

In addition to benefiting from public health programs for all Americans, American Indians and Alaska Natives are eligible for health services from the Indian Health Service (IHS), U.S. Public Health Service. Indian Health Service provides comprehensive health services, including nutrition and dietetics, to American Indians and Alaska Natives living on or near federal Indian reservations or in traditional Indian territory, such as Oklahoma and Alaska. Dramatic improvements have occurred in the health of native Americans since IHS was transferred to the Public Health Service in 1955. Infant mortality rate, maternal deaths, and deaths related to infectious diseases have all decreased. Chronic diseases are now major causes of death. Nutritional factors contribute to at least 4 of the 10 leading causes of American Indian and Alaska Native deaths--heart disease, cancer, cirrhosis, and diabetes--and to the prevalence of overweight, obesity, hypertension, and dental caries. There is still incomplete information on nutritional status and present dietary patterns, nutritive values of native foods, and nutrition education knowledge of the population. Priority nutrition objectives have been developed to address those issues.

Female↗
PubMed2003

Community based program to improve firearm storage practices in rural Alaska.

OBJECTIVE: To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households. DESIGN: Pilot intervention with pre/post-evaluation design. SETTING: Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska. SUBJECTS: Forty randomly selected households with two or more guns in the home. INTERVENTION: Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants. MAIN OUTCOME MEASURES: Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks. RESULTS: All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use. CONCLUSIONS: This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.

Adolescent↗