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PubMed2004

Culture, trauma, and wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit native americans.

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance use. Compared with their heterosexual counterparts, two-spirit participants reported higher rates of childhood physical abuse and more historical trauma in their families, higher levels of psychological symptoms, and more mental health service utilization. Two-spirit participants reported differences in patterns of alcohol use and were more likely to have used illicit drugs other than marijuana. Discussion and recommendations for health promotion interventions and future research are presented in consideration of an "indigenist" health model and the multiple minority status of two-spirit people.

Adolescent↗
PubMed1998

Health status of American Indians/Alaska Natives: general patterns of mortality.

BACKGROUND AND OBJECTIVES: Investigations of American Indian and Alaska Native (AI/AN) populations suggest patterns of mortality that differ from the general population. Mortality data reveal excess overall mortality among AI/ANs, as well as excesses for specific causes of death, including accidents, diabetes, liver disease, pneumonia/influenza, suicide, homicide, and tuberculosis. A relative deficit of deaths has been noted for heart disease, cancer, and HIV infections. It is important that physicians demonstrate cultural competence so they may provide quality medical care for the populations they serve. Activities such as provider education, risk assessment, and emphasis on preventive services are offered to facilitate integration into teaching curricula. Knowledge of distinctive mortality patterns among AI/ANs will help clinicians recognize the unique needs of these patients.

Accidents↗
PubMed1993

Prevalence of diabetes mellitus in pregnancy among Yup'ik Eskimos, 1987-1988.

OBJECTIVE: To evaluate the prevalence of diabetes mellitus in pregnancy in Yup'ik Eskimos. RESEARCH DESIGN AND METHODS: A retrospective review of consecutive birth-log data and medical records was conducted. Records were taken from the primary care and tertiary referral facilities in Alaska Area Native Health Service. Some 630 consecutive deliveries were reviewed from 1 March 1987 to 29 February 1988, with 25 excluded for ancestry other than Alaska Native. Another 605 Alaska Native patient charts were reviewed, with 545 Alaska Native patients screened for diabetes in pregnancy. The study population had a mean age of 25.6 yr, mean gravidity of 3.4, mean parity of 1.9, and mean birth weight of 3567 +/- 493 g. RESULTS: Patients were screened with a 50-g glucose oral load with a plasma glucose 1 h later. 156 of 605 (25.7%) patients, with a screen > or = 7.8 mM received a 100-g OGTT. Of 605, 35 (5.8%) patients met O'Sullivan criteria, and 2 of 605 (0.3%) patients met WHO criteria for previous diabetes mellitus, for a total 37 of 605 (6.7% [corrected]) women with diabetes in pregnancy. The subjects who met O'Sullivan criteria had statistically greater mean age (29.9 yr), gravidity (4.9), parity (2.9), and birth weight of their infants (3678 +/- 389 g), compared with women with a screen < 7.8 mM. CONCLUSIONS: The prevalence of diabetes in pregnancy among Yup'ik Eskimos is twice the rate for the U.S. for all races, despite the Yup'ik having the lowest rate of diabetes mellitus among Alaska Natives. This may represent a large number of undiagnosed patients with impaired glucose tolerance, and may reflect the wide-spread dietary and life-style changes that have occurred in the Yup'ik in the last 30 yr. The Yup'ik present a unique opportunity to apply prevention techniques in a population with an emerging problem with glucose tolerance.

Adult↗
PubMed2006

Health behaviors among American Indian/Alaska Native women, 1998-2000 BRFSS.

BACKGROUND AND OBJECTIVE: Minority populations, including American Indians and Alaska Natives (AI/AN), in the United States generally experience a disproportionate share of adverse health outcomes compared with whites. The prevalence of risk behaviors associated with these adverse health outcomes among AI/AN women is not well documented, especially for those who live outside areas serviced by Indian Health Service. We sought to describe the prevalence of selected health risk behaviors among AI/AN women, document the disparities between AI/AN women and all U.S. women, and demonstrate the efforts needed for AI/AN women to reach Healthy People 2010 goals. METHODS: Age-adjusted prevalence estimates for selected sociodemographic characteristics, current smoking, obesity, lack of leisure time physical activity, and binge drinking were calculated using Behavioral Risk Factor Surveillance System (BRFSS) data from 1998 to 2000, combined. Comparisons were made between prevalence estimates for AI/AN women and all women who participated in the BRFSS and Healthy People 2010 goals. RESULTS: The prevalences of current smoking (27.8%) and obesity (26.8%) were significantly higher among AI/AN women than among all U.S. women. AI/AN women did not meet Healthy People 2010 goals for current smoking, obesity, leisure time physical activity, or binge drinking. CONCLUSIONS: These data highlight both disparities in health risk behaviors between AI/AN women and all U.S. women and improvements needed for AI/AN women to meet Healthy People 2010 goals. This project demonstrates the overwhelming need for culturally appropriate and accessible prevention programs to address health risk behaviors associated with the leading causes of death among urbanized AI/AN women.

Alcohol Drinking↗
PubMed2005

Reforming American Indian/Alaska Native health care financing: the role of Medicaid.

Chronic underfunding of American Indian and Alaska Native (AIAN) health care by the federal government has weakened the capacity of the Indian Health Service, tribal governments, and the urban Indian health delivery system to meet the health care needs of the AIAN population. I describe the current role of Medicaid in financing health care services for American Indians/Alaska Natives and offer 3 suggestions for reforming Medicaid financing of AIAN health care: (1) apply a 100% federal matching rate to the cost of Medicaid services furnished by urban Indian health programs; (2) apply a 100% federal matching rate to the cost of Medicaid services furnished by referral to AIAN patients of hospitals or clinics operated by the Indian Health Service, tribes, tribal organizations, or urban Indian health programs; and (3) exempt AIAN Medicaid beneficiaries who receive services from such hospitals or clinics from state reductions in Medicaid eligibility and benefits.

Health Care Reform↗
PubMed2002

Kidney disease in Native Americans.

Over the past few decades, the disease burden among American Indians and Alaska Natives (Al/AN) has shifted from acute infectious diseases to chronic illnesses, particularly type 2 diabetes and its complications. AI/ANs experience high rates of end-stage renal disease (ESRD), mainly driven by the increase in diabetes. The prevalence of ESRD is 3.5 times greater than that in white Americans. The burden of ESRD has become a community-wide problem among many tribes, and significant efforts have gone into establishing dialysis services on reservations. Reservation-based dialysis services have improved the access of patients to renal replacement therapy, but enormous barriers to improving care remain. These include: the rural and frequently isolated locations that make traveling to facilities difficult owing to distance and road conditions; high rates of poverty; difficulty in recruiting and retaining staff in outlying areas; language and cultural differences; and the high numbers of patients with diabetes and extra-renal diabetic complications. Disparities exist in access to kidney transplantation, with AI/ANs waiting longer for organs than their white counterparts. However, once transplanted, they have comparable survival rates to white Americans. An aggressive approach to intervention, which includes prevention and optimal therapy, is required to slow the growth of ESRD amongst AI/ANs.

Albuminuria↗
PubMed1992

Epidemiology of injuries in northern areas.

Traumatic injuries are among the leading causes of death in Alaska and the arctic. Intentional injuries (homicide and suicide) and unintentional injuries (motor vehicle crashes, drowning, aviation crashes, alcohol and other drugs) cause 29% of all deaths and 53% of all years of potential life lost (YPLL) in Alaskans. Mortality and morbidity rates due to injuries remain higher among Alaska Natives than other racial groups. The occupational fatality rate in Alaska (33 deaths per 100,000 workers) is the highest in the United States and is largely due to the large number of deaths among commercial fishermen, airplane pilots, sailors, truck drivers, and loggers. Effective injury control and prevention efforts are hampered by lack of adequate surveillance systems. Injury research and public health control measures are unfocused, lack continuity, and are undersupported.

Alaska↗
PubMed2005

Supplemental standards of ethical conduct and financial disclosure requirements for employees of the Department of Health and Human Services. Interim final rule with request for comments.

The Department of Health and Human Services, with the concurrence of the Office of Government Ethics (OGE), is amending the HHS regulation that supplements the OGE Standards of Ethical Conduct. This interim final rule specifies additional procedural and substantive requirements that are necessary to address ethical issues at the National Institutes of Health (NIH) and updates nomenclature, definitions, and procedures applicable to other components of the Department. The rule: Revises the definition of a significantly regulated organization for the Food and Drug Administration (FDA); Updates the organization titles of designated separate agencies; Amends the gift exception for native artwork and craft items received from Indian tribes or Alaska Native organizations; Aligns the FDA prohibited holdings limit with the de minimis holdings exemption in OGE regulations; Revises prior approval procedures for outside activities; and, subject to certain exceptions: Prohibits NIH employees from engaging in certain outside activities with supported research institutions, health care providers or insurers, health-related trade or professional associations, and biotechnology, pharmaceutical, medical device, and other companies substantially affected by the programs, policies, or operations of the NIH; Bars NIH employees who file a public or confidential financial disclosure report from holding financial interests in substantially affected organizations; Subjects NIH non-filer employees to a monetary cap on holdings in such organizations; Specifies for NIH employees prior approval procedures for and limitations on the receipt of certain awards from outside sources; and Imposes a one-year disqualification period during which NIH employees are precluded from official actions involving an award donor. In addition, the Department is adding a new supplemental part to expand financial disclosure reporting requirements for certain outside activities and to ensure that prohibited financial interests are identified.

Awards and Prizes↗
PubMed1981

Delayed development of antibody to hepatitis B surface antigen after symptomatic infection with hepatitis B virus.

During a 2-year period, 38 patients with clinical hepatitis B virus infection were seen at the Public Health Service Alaska Native Hospital in Bethel. This hospital serves an area in southwest Alaska that is hyperendemic for hepatitis B virus. The patients came to the hospital at various times from 15 scattered villages, and 92% were Eskimo. None of the patients had a recent history of hypodermic injection or blood transfusions. Twenty-five patients, all originally positive for hepatitis B surface antigen (HBsAg), were followed for up to 5 years after onset of illness, and 15 were either slow to develop, or never developed, antibody to HBsAg (anti-HBs), although only one patient became a chronic carrier of HBsAg. Six patients had a prolonged "window phase" between the disappearance of HBsAg and the appearance of anti-HBs which lasted for more than 1 year. Three patients had only transient anti-HBs after HBsAg disappeared, and five never developed measurable anti-HBs at all. All patients had antibody to hepatitis B core when both HBsAg and anti-HBs were absent. In contrast to studies in other populations, only 42% had anti-HBs 1 year after onset of illness, 63% had it at 18 months, 70% had it at 2 years, and 80% had it at 5 years. Factors related to ethnicity might account for the differences in the development of anti-HBs after acute symptomatic hepatitis B virus infection seen in Eskimos when compared with whites.

Adolescent↗
PubMed1987

Pacific northwest native American youth and smokeless tobacco use.

This study examined snuff and chewing tobacco use among Alaska Native and American Indian adolescents. Results show frequent and early use of smokeless tobacco products. Almost one fifth of all females and close to one half of all males had used snuff or chewing tobacco on more than 20 occasions. Weekly smokeless tobacco use was reported by 34% of all females and by 42.6% of all males. By product type, 32.6% of all subjects had used snuff and 27.8% had chewed tobacco in the past week. Among females, over one half of all subjects had used snuff or chewing tobacco before age 10 years. Among males, nearly one half of the subjects first used smokeless tobacco prior to 8 years of age. Few subjects had used cigarettes or other smoked tobacco products.

Alaska↗
PubMed2000

Urban native American health issues.

BACKGROUND: This article presents an overview of urban-dwelling American Indians and Alaska Natives, including a summary of data issues and a brief overview of historical and related social changes resulting in migration from reservations to urban areas. METHODS: A literature search was performed and documented focus groups were held; in addition, Native Sisters' field records from Los Angeles, California, and Denver, Colorado, were reviewed. RESULTS: Urban Indian communities are intertribal and represent over half of the Native American population in the U.S., yet they lack access to sufficient health services. Urban Indian clinics are greatly underfunded. CONCLUSIONS: A greater proportion of funding needs to be allocated to community-driven, culturally respectful, multiyear behavioral research to improve the screening, treatment, and survival of American Indian women with breast carcinoma.

Alaska↗
PubMed1975

Phlyctenular keratoconjunctivitis: results of penetrating keratoplasty in Alaskan natives.

Corneal scarring secondary to inactive phlyctenular keratoconjunctivitis (PKC) is a significant cause of decreased vision in Alaskan Natives. The results of primary penetrating keratoplasty for such cases at the Alaska Native Medical Center form the basis of this report. Eighteen cases met the criteria established for this study. Fourteen (79 percent) had clear grafts at least six months after surgery (average follow-up: 46 months). Of the twelve grafts performed using 10-0 nylon and the operating microscope, 11 (92 percent) were clear. Twelve of the 14 persons with clear grafts had improved vision of at least two lines on the Snellen chart. On the basis of this report, penetrating keratoplasty for corneal scarring due to PKC seems to have a favorable prognosis.

Adolescent↗
PubMedDate not supplied

Patterns in cancer incidence among American Indians/Alaska Natives, United States, 1992-1999.

OBJECTIVE: Cancer is a major public health concern in American Indian and Alaska Native (AI/AN) communities. However, information on the incidence of cancer is lacking for this group. The purpose of this study is to report cancer incidence patterns for the U.S. AI/AN population. METHODS: Age-adjusted annual cancer incidence rates for 1992 through 1999 were calculated for 12 Surveillance, Epidemiology and End Results (SEER) areas, representing a sample (42%) of the U.S. AI/AN population. Trends in cancer incidence rates for the AI/AN sample were determined using standard linear regression of log-transformed rates and were compared to those of the U.S. white population. RESULTS: The top five incident cancers (from highest to lowest) among AI/AN males were prostate, lung and bronchus, colon and rectum, kidney and renal pelvis, and stomach cancers. Among AI/AN women, cancers of the breast, colon and rectum, lung and bronchus, endometrium, and ovary ranked highest. Four sites where cancer incidence rates are greater for AI/ANs than for whites include gallbladder (the AI/AN rate was 4.1 times the rate for white males and 2.6 times the rate for white females), liver and intrahepatic bile duct cancers (1.3 times for males and 2.3 times for females), stomach (1.2 times for males and 1.5 times for females), and kidney and renal pelvis (1.03 times for males and 1.07 times for females). The data show increasing trends for AI/AN males and females and declining trends for white males and females for colorectal, stomach, and pancreatic cancers and leukemia. Similar differences between AI/AN rates and white rates were found for urinary bladder cancers in males and gallbladder cancer in females. CONCLUSIONS: Analysis of SEER data allowed for the determination of disparities in cancer incidence between a sample of the U.S. AI/AN population and the white population. The findings of this study provide baseline information necessary for developing cancer prevention and intervention strategies specific to the AI/AN population to address these cancer disparities.

Adult↗
PubMed1996

The potential impact of cancer survivors on Native American cancer prevention and treatment.

Cancer has recently become a major health problem for American Indians and Alaska Natives. Surveillance, Epidemiology, and End Results data showed that Native American survival rates at 1, 3, and 5 years from cancer diagnosis are the poorest of any minority population studied. The causes for this finding are multifactorial and include a lack of awareness of cancer risks and symptoms, fatalism, and lack of access to screening services. Cancer survivors in native communities can be invaluable resources to educate others, raise cancer awareness, and most importantly prove that cancer is not always fatal.

Adaptation, Psychological↗
PubMed2006

Decline in respiratory syncytial virus hospitalizations in a region with high hospitalization rates and prolonged season.

BACKGROUND: During 1993 to 1996, Alaska Native infants <1 year of age from the Yukon Kuskokwim (YK) Delta in Alaska experienced a respiratory syncytial virus (RSV) hospitalization rate 5 times the U.S. general infant population rate. We describe trends in lower respiratory tract infection (LRTI) and RSV hospitalizations in YK children from 1994 to 2004. METHODS: We abstracted hospital dates, RSV test results and clinical information from the hospital records for YK children <3 years of age hospitalized between July 1994 and June 2004. RESULTS: : The RSV hospitalization rate in YK Delta children <1 year of age decreased from 178 per 1000 infants per year (1994-1997) to 104 per 1000 infants per year (2001-2004) (P < 0.001), and the RSV hospitalization rate for premature infants decreased from 317 to 123 per 1000 infants per year (P < 0.001). The risk reduction for RSV hospitalization was greater in premature (relative risk, 0.39) than in term infants (relative risk, 0.60; P = 0.04). The rate of non-RSV LRTI hospitalizations increased from 153 to 215 per 1000 infants per year (P < 0.001). The median RSV season length was 30.5 weeks. Pneumonia was diagnosed in more than half of RSV admissions. CONCLUSIONS: In YK infants, the RSV hospitalization rate decreased by one-third between 1994 and 2004; however, the overall LRTI hospitalization rate did not change. The median RSV season was twice as long as for the U.S. population. Palivizumab prophylaxis may be responsible for the larger decrease in the RSV hospitalization rate among premature infants; however, the 2001-2004 RSV hospitalization rate among YK infants remained 3 times higher than the U.S. infant rate.

Alaska↗
PubMed2001

Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women--United States, 1991-1997.

In the United States in 1997, the Hispanic, Asian/Pacific Islander, and American Indian/ Alaska Native population represented 16% of all reproductive-age women (aged 15-49 years) but accounted for 23.5% of all live births (1,2). Although statistics by race/ethnicity are available for maternal deaths (3), pregnancy-related mortality ratios (PRMRs) have been reported regularly only for black and white women. Pregnancy-related deaths in Hispanic women have been studied (4); however, combining pregnancy-related mortality risk among Asians/Pacific Islanders and American Indians/Alaska Natives into an "other" category masks differences in their health status. This report presents PRMRs among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women in the United States during 1991-1997. The findings indicate that these groups have higher PRMRs than non-Hispanic white (white) women and lower ratios than non-Hispanic black (black) women and underscore the need for targeted interventions that address the maternal health needs of racial/ethnic minority women.

Adolescent↗
PubMed1994

Provision of cancer control services to Native Americans by state health departments.

To examine the extent of cancer prevention and control programs for American Indian and Alaska Native (AI/AN) tribal groups directly supported by state public health agencies, a cross-sectional survey was completed by chronic disease directors in 50 states. Descriptive statistics were used to summarize responses. Sixteen states (32%) reported having sponsored/directly supported cancer prevention and cancer control services specifically targeted to AI/AN populations. Few state public health agencies had developed culturally-relevant cancer education materials for AI/ANs. Although the respondents directed chronic disease or cancer prevention/control programs in their states, many were unfamiliar with cancer patterns or general health problems among AI/ANs. Survey results indicate that cancer prevention and control services are available to AI/AN populations through most state public health agencies. It is hoped that dissemination of survey results will increase awareness of cancer as a health problem among AI/ANs and lead to an expansion of the services available to this "invisible minority" to levels accessible by the majority population.

Cross-Sectional Studies↗