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PubMedDate not supplied

The prevalence of tobacco use among Alaska adults.

The Alaska Division of Public Health monitors the prevalence of smoking and other tobacco use among Alaska adults through the Alaska Behavioral Risk Factor Surveillance System, a telephone survey performed in cooperation with the U.S. Centers for Disease Control and Prevention (CDC). A total of approximately 1530 interviews are completed each year in Alaska by specially trained interviewers. The prevalence of smoking among Alaska adults in 1994 (28.9%) was second highest in the U.S. Alaska Natives have higher smoking rates (42.9%). Overall, smoking rates have declined in the last three decades nationally. However, in recent years, little change has been found in the prevalence of smoking among adults. Alaska's rate of smokeless tobacco use has also been higher than the national rate of use. The majority of Alaska smokers (83.7%) began smoking between 10 and 20 years of age. In 1994, an estimated 121,000 Alaska adults aged 18 and older were current smokers.

Adolescent↗
PubMed2005

Rural American Indian Medicaid health care services use and health care costs in California.

OBJECTIVES: We determined differences in Medicaid service use and health care costs in a rural Indian Health Service (IHS) user population of American Indians and Alaska Natives as compared with Whites. METHODS: California Medicaid eligibility and claims files were linked to IHS user files to obtain a sample of Medicaid-eligible American Indian/Alaska Native users (n=7910). A random sample of Whites was matched for age, gender, aid category, length of eligibility, and county of residence (n=15075). We used generalized linear models to compare risk-adjusted use of resources-ambulatory visits, prescriptions, emergency room visits, hospitalizations, and costs-both adjusting and stratifying for dominant source of ambulatory visits. RESULTS: American Indians/Alaska Natives had significantly lower use of Medicaid-paid ambulatory visits, prescriptions, emergency room visits, and hospitalizations and lower associated costs than Whites. Medicaid-paid total costs and use of services were lower for those who predominantly used Indian health program clinics, as well as for those who predominantly used other sources of ambulatory care. CONCLUSIONS: Barriers to receiving Medicaid services and payments exist for American Indians/Alaska Natives in the rural IHS-user population. If American Indians/Alaska Natives are to have Medicaid resources comparable to those of Whites, these barriers must be reduced.

Adult↗
PubMed1998

Investigating cancer clusters.

A cluster is a mini-epidemic of a rare disease. Clusters may give clues to the etiology of disease, or may signal a hazardous exposure. Unfortunately, cluster investigations seldom are conclusive, for several reasons. Statistically significant clusters can occur by chance. The probability of finding chance cancer clusters is calculated for the 200 Alaska Native villages. The problem of selection bias is explained, and other limitations of epidemiology are described. A logical, stepwise protocol for investigating cancer clusters is presented.

Alaska↗
PubMedDate not supplied

National Cancer Institute's Native American cancer research projects.

The purpose of this paper is to briefly describe several of the NCI Native American initiatives that illustrate the diversity and breadth of NCI's commitment to indigenous peoples. The National Cancer Institute (NCI) began introducing Native American cancer initiatives in 1987. Initiatives which are described in the paper include the following: four intervention research projects on cervical and breast cancer among Native Americans; four intervention research projects on the prevention of tobacco and dietary cancer risk factors among American indians; investigator-initiated developmental research grants on cervical and breast cancer; intra-agency agreements with the Indian Health Service; the Network for Cancer Control Research among American Indian and Alaska Native Populations; Native American Training Opportunities Meeting; Data-based Intervention Research projects which focus on Native Americans.

Female↗
PubMedDate not supplied

Death in Anchorage in 1986.

In 1986, 886 persons died in Anchorage compared to 863 in 1985. The crude death rate was essentially the same in the two years. When age-adjusted, the 1986 Anchorage death rate was higher than in the nation. From 1985 to 1986, cardiovascular deaths increased, cancer deaths were unchanged, and mortality from violence decreased. However, the rate of violent deaths was still three times the national rate and was especially high among Alaska Natives. Motor vehicle fatalities were distinctly fewer in 1986 but continued to be strongly linked to alcohol consumption. Every twenty-first death was from gunfire. Cocaine directly caused eight deaths.

Alaska↗
PubMed1982

Cancers of the gallbladder and biliary tract in Alaskan natives: 1970--79.

The records of Alaskan Native patients with gallbladder and extrahepatic bile duct cancers diagnosed during 1970--79 were reviewed. Of 34 cases identified, the primary cancer was in the gallbladder in 29, resulting in age-adjusted incidence rates for gallbladder cancer of 4.4 for males and 17.6 for females. On the basis of calculations applying cancer incidence rates for U.S. whites to the Alaska Native population, a greater than expected number of both Eskimo and Indian patients were diagnosed. A 5-year review of cholecystectomies indicated that nonmalignant gallbladder disease was also elevated in both Indians and Eskimos.

Adenocarcinoma↗
PubMed1998

Integrated primary care.

The delivery of medical and health-related services tends to be compartmentalized and fragmented. If the goal is health and if an important part in achieving that goal is increasing the ability of the person, family, and community to care for themselves while providing cost-effective care, then it is imperative to integrate efforts across community and primary care arenas. The Southcentral Foundation is an Alaska Native organization focused on the delivery of community and primary care activities that continues to work at the challenges of integration and coordination. This paper discusses some of the efforts to date and hopes for the future.

Alaska↗
PubMedDate not supplied

Kawasaki disease. Kawasaki disease?

Four cases of Kawasaki Disease (KD) treated at Bartlett Regional Hospital, Juneau, AK, are reviewed and discussed. Diagnostic and therapeutic measures recommended by the American Heart Association were followed and these cases discussed. Another case of probable Kawasaki Disease occurring in Anchorage, Alaska Native Medical Center, in 1965, is presented and compared with the other four. Current management of KD, with intravenous gamma globulin (IVGG) and aspirin (ASA) is highly effective, but was not known or available in 1965.

Alaska↗
PubMed1983

Alcohol and alcoholism in Alaska: research in a multicultural and transitional society.

Working and living in Alaska, where social and cultural transitions are taking place, allows one the opportunity to reflect on the methods and procedures involved in one's discipline and/or research orientation. This article thus provides a review of what is happening in Alaska with respect to alcohol use by Alaska Natives and reflects on the issues involved when traditional cross-cultural research procedures are followed. Questions are also raised concerning what the focus of research might be, and suggestions for more culturally relevant research are advanced.

Adult↗
PubMedDate not supplied

Comparison of BMI and body fat determinations in rural Alaska women: results of the WIC Healthy Mom Survey, Summer 2001.

OBJECTIVES: Evaluate two field methods to assess body composition of rural Alaska women. Excess body fat has been correlated with chronic diseases. METHODS: This exploratory study used an orally administered survey of a self-selected sample from five rural Alaskan villages. Electrical impedance technique was used to determine percent of body fat. Body Mass Index (BMI) was calculated based on clinically obtained height and weight and compared to historical data by geographical regions. Self-reported health data and fingerstick screenings were used to assess health status. RESULTS: The body mass index tool assessed more women at excessive weight than did the percent body fat assessment tool. Fingerstick screenings for glucose, cholesterol, and hemoglobin were generally found to be in normal ranges. CONCLUSIONS: Percent of body fat may be more accurate to determine weight status for many Alaska Native women. Historical body mass indices may indicate periods of prolonged limited food supplies for a geographic region.

Adipose Tissue↗
PubMed1998

Patterns of cancer mortality among Native Americans.

BACKGROUND: Native Americans have been reported to have lower cancer incidence and mortality than other racial groups in the U.S., although some have questioned whether this was due to racial misclassification. This study provides improved estimates of cancer mortality, determined from a sampling of people who live on Indian reservations. METHODS: The authors reviewed death certificates from U.S. counties that contain Indian lands, excluding certain areas with known problems of racial misclassification. Age-adjusted mortality rates for specific types of cancer were calculated using U.S. Census population figures, and these rates were compared with rates for all races in the U.S. RESULTS: This sample included 38% of the American Indian and Alaska Native populations. The age-adjusted annual mortality rate for all cancers combined was 148.2 per 100,000 for both genders, 133.1 for females, and 167.2 for males. The rates for males and for both genders combined, but not for females, were significantly lower than the U.S. rates for all races (P < 0.05). Females had significantly lower rates of death from carcinoma of the lung and breast and significantly higher rates of death from carcinoma of the cervix and gallbladder (P < 0.05). Males had significantly lower rates of death from carcinoma of the lung, colon, and prostate, and significantly higher rates of liver carcinoma. Both genders combined had significantly lower rates of death from lung and colon carcinoma and significantly higher rates of death from stomach, liver, kidney, and gallbladder carcinoma. Geographic differences were substantial, with the Northern and Plains regions experiencing much higher mortality from lung, colon, and breast carcinoma than the Southwest region. CONCLUSIONS: Compared with the general U.S. population, Native Americans experience quite different patterns of cancer mortality. Cancer prevention and control programs should be designed specifically for this minority population.

Alaska↗
PubMed2005

Balancing empiricism and local cultural knowledge in the design of prevention research.

Prevention research aims to address health and social problems via systematic strategies for affecting and documenting change. To produce meaningful and lasting results at the level of the community, prevention research frequently requires investigators to reevaluate the boundaries that have traditionally separated them from the subjects of their investigations. New tools and techniques are required to facilitate collaboration between researchers and communities while maintaining scientific rigor. This article describes the tribal participatory research approach, which was developed to facilitate culturally centered prevention research in American Indian and Alaska Native communities. This approach is discussed within the broader context of community-based participatory research, an increasingly prevalent paradigm in the prevention field. Strengths and limitations of the approach used in the study are presented.

Advisory Committees↗
PubMed1998

Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative prevalence derived from multiple data sources.

OBJECTIVES: The prevalence and characteristics of fetal alcohol syndrome cases and the usefulness of various data sources in surveillance were examined in Alaska to guide prevention and future surveillance efforts. METHODS: Sixteen data sources in Alaska were used to identify children with fetal alcohol syndrome. Medical charts were reviewed to verify cases, and records were reviewed to provide descriptive data. RESULTS: Fetal alcohol syndrome rates varied markedly by birth year and race, with the highest prevalence (4.1 per 1000 live births) found among Alaska Natives born between 1985 and 1988. Screening and referral programs to diagnostic clinics identified 70% of all recorded cases. The intervention program for children 0 to 3 years of age detected 29% of age-appropriate cases, and Medicaid data identified 11% of all cases; birth certificates detected only 9% of the age-appropriate cases. CONCLUSIONS: Our findings indicate a high prevalence of fetal alcohol syndrome in Alaska and illustrate that reliance on any one data source would lead to underestimates of the extent of fetal alcohol syndrome in a population.

Adolescent↗
PubMed1996

Lipoprotein profiles in Alaskan Siberian Yupik Eskimos.

Coronary heart disease and diabetes, once rare in Eskimos, is on the increase in some Alaskan communities. As part of a detailed assessment of the prevalence of these diseases and associated risk factors in several villages, we report here on the plasma concentrations of lipoprotein and apoprotein in a sample of Siberian Yupik Eskimos aged 40-87 years living in the village of Gambell on St. Lawrence Island. Mean cholesterol levels for females were 242 mg/dl and 223 for males. LDL levels were 161 for females and 149 for males, while HDL levels were 67 for females and 58 for males. The mean ApoB and Apo-A1 values were 112 mg/dl and 167 mg/dl for males and females. Triglycerides were 73 for females and 77 for males. The allele frequency of APOE*3 and APOE*4 were .900 and .100 respectively. There was a total absence of the APOE*2 allele in this sample. Mean total cholesterol concentrations in this sample were markedly higher than those reported in 1958 from this village and from those recently reported for closely related Yupik Eskimos living in Siberia. The cholesterol levels were higher and the triglyceride levels were lower than in U.S. Indian populations. The data suggest the possibility of recent increased risk of cardiovascular disease for this Eskimo population. The new information indicates a need for comprehensive epidemiological studies to identify and characterize cardiovascular disease risk factors in all Alaska Native populations in order to provide a database for meaningful interventions. The lipoprotein profiles reported here are significantly different from Amerind groups, a finding that may reflect both dietary and genetic differences.

Adult↗
PubMed1998

Incidence rates, clinical features, and case identification of pediatric tuberculosis in Alaska.

SETTING: The population of Alaska. OBJECTIVE: To determine incidence rates, clinical features, and source of case identification for pediatric tuberculosis in Alaska. DESIGN: A state-wide, population-based, retrospective analysis of all cases of tuberculosis among children 0 to 14 years of age reported to the Alaska Division of Public Health during 1987-1994. RESULTS: Seventy children with tuberculous disease were identified for an incidence rate of 5.8/100000/year. Compared to whites, Alaska Natives (relative risk [RR], 65; 95% confidence interval [CI], 20 to 207) and people of other races (RR, 21; 95% CI, 5.6 to 79) had an increased risk of tuberculosis. Clinical features did not differ by race. Twenty-three of 45 persons with at least one specimen collected had a positive culture result, including three with isoniazid-resistant strains. While most cases were identified through contact investigations, 23% were identified through required school screening. CONCLUSION: Alaska has a high rate of pediatric tuberculosis, with non-white race identified as a risk factor. Required school screening proved useful for case identification.

Adolescent↗
PubMed2001

Nutaqsiivik--an approach to reducing infant mortality using quality improvement principles.

The Alaska Native Medical Center, one of nine teams that participated in the Institute for Health Care Improvement's Community-Wide Learning Collaborative, used quality improvement principles to address a disparately high post-neonatal infant mortality in the Anchorage Native infant population. A unique concept, "Days Between Deaths," was used to measure mortality change for a small data set. Ongoing evaluation processes have demonstrated a fifty percent reduction in infant mortality and very successful approaches to care for high social risk women and their families.

Alaska↗
PubMed2004

Evaluation of a training program to prepare community health representatives to promote breast and cervix cancer screening among native american women.

BACKGROUND: Native American women have very poor 5-year breast and cervix cancer survival rates compared to other US population groups. We evaluated a training program that prepares community health representatives (CHRs) to promote prevention and early detection of these diseases. Two questions guided the evaluation: (1) Are CHRs an appropriate focus of training? and (2) Does training empower CHRs and, indirectly, their facilities to educate about breast and cervix cancer, promote screening, and teach breast self-exam skills to American Indian and Alaska Native women? METHODS: Twenty CHRs (3 Indian Health Service regions, 9 separate employers) responded to a telephone survey consisting of Likert scale and multiple option and short-answer questions. Analysis relied on descriptive statistics and measures of central tendency. RESULTS: By tenure, cultural and community membership, and ability to adapt to audience needs and setting demands, CHRs make appropriate training recipients. Training improves skills and their use and appears to increase employers' reliance on CHRs for screening promotion and education about cancer. Posttraining, more women hear and heed the screening message. CONCLUSIONS: CHRs are an appropriate focus of training. Training leads to increased screening-related activities and should be continued and expanded.

Breast Neoplasms↗
PubMedDate not supplied

Health care programs for scattered populations.

Health care for scattered populations is discussed. An optimal system applying current technology is described emphasizing the economic supportability of such a system. This is accomplished by basing the system on health auxiliaries and middle level health personnel who have undergone problem oriented training and who receive regular supervision. The Alaska Native Health Program is described in detail. Several other health care systems in use in sparsely populated areas of the world are reported on. Emergency care as a particular and essential aspect of any health care program for isolated populations is discussed. Finally future trends including current experiments utilizing satellite technology are reported on.

Alaska↗