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PubMed2003

Tribal participatory research: mechanisms of a collaborative model.

Although much social science research has been conducted within American Indian and Alaska Native (AIAN) communities, relatively little research has been conducted by or for those communities. We describe an approach that facilitates the active involvement of AIAN communities in the research process, from conceptualizing the issues to be investigated to developing a research design, and from collecting, analyzing, and interpreting the data to disseminating the results. The Tribal Participatory Research (TPR) approach is consistent with recent developments in psychology that emphasize the inclusion of community members and the social construction of knowledge. We describe the foundations of the approach and present specific mechanisms that can be employed in collaborations between researchers and AIAN communities. We conclude with a discussion of the implications of the use of TPR regarding project timelines and budgets, interpretation of the data, and ultimately the relationships between tribes and researchers.

Community Participation↗

PubMed1999

Culturally related anxiety and ethnic identity in Navajo college students.

The Cultural Involvement and Detachment Anxiety Questionnaire (D. W. McNeil, C. A. Porter, M. J. Zvolensky, & J. M. Chaney, 1998) and the Multigroup Ethnic Identity Measure (J. S. Phinney, 1992) were administered to 160 Navajo college students to explore the relation between ethnic identity and culturally related anxiety, compare level of ethnic identity in reference to standardized samples, and test for gender differences. Correlations indicated a notable lack of relation between ethnic identity and cultural anxiety. This particular Navajo sample evidenced significantly higher levels of ethnic identity in comparison to students of Caucasian, Asian, Hispanic, or mixed ethnicity. There were no significant gender differences in culturally related anxiety. Results are discussed in relation to culturally related anxiety and ethnic identity in the Navajo, with implications for better understanding the nature of cultural anxiety in other American Indians and Alaska Natives.

Adult↗

PubMed2003

The spectrum of kidney disease in American Indians.

American Indians and Alaska Natives (AI/AN) experience high rates of chronic kidney disease. Several studies have demonstrated increased rates of early kidney disease among AI/AN, both in diabetics and non-diabetics. Among some tribes of the American Southwest, high rates of mesangiopathic glomerulonephritis have been documented. The epidemic of diabetes among AI/AN, which began in the middle of the 20th century, appears to be driving the increase in end-stage renal disease (ESRD). At the end of 1999, AI/AN had a national prevalence rate of treated ESRD that was 3.5 times greater than that of white Americans. There is significant regional variation as well as differences among the approximately 550 tribes that make up the American Indian community, with some tribes experiencing ESRD rates over twenty times the rate of whites. Although graft survival is excellent, AI/AN ESRD patients are less likely than whites to be placed on the transplant waiting list, and those listed wait longer for a transplant. Despite socioeconomic barriers and high rates of co-morbid illness, survival among AI/AN ESRD patients is better than among whites. The burden of kidney disease, particularly the multigenerational occurrence in some families, is perceived as a major threat to the well-being of native communities. There is a sense of urgency among tribal leaders to address this epidemic, and research that may decrease its burden is likely to be welcomed.

Humans↗

PubMed2005

Oral disease prevalence among HIV-positive American Indians in an urban clinic.

Abstract-According to Centers for Disease Control and Prevention (CDC) estimates, there have been almost 930,000 AIDS cases diagnosed at the end of 2003 in the United States. About 3,000 of those infected were American Indian and Alaska Natives (AI/ANs). Persons with HIV and AIDS have been shown to have increased risk of dental and periodontal disease. Unfortunately, there are no publications on dental disease and AI/ANs with HIV/AIDS. This study addresses this shortcoming by examining the relationship between dental health, drug use, and HIV among AI/AN patients in an urban setting. The study included a consecutive chart review of 51 AI/AN HIV-positive dental patients seen from 2001 to 2004 at the Native American Health Center in San Francisco. Results showed that 55% had moderate or severe periodontal disease, 80.4% had tooth decay, and 88.2% had missing teeth. Substance users had more dental caries or decayed teeth than non-substance users (88% versus 73%). The average rate for decayed, missing or filled teeth (DMFT) among the total sample was 18.73%. This chart review study suggests that dental disease is more prevalent in AI/ANs with HIV/AIDS when compared to the general population and AI/AN data from the Indian Health Service.

Adult↗

PubMed2005

Using motivational interviewing to promote HIV testing at an American Indian substance abuse treatment facility.

Alcohol and drug use are associated with increased risk of HIV/AIDS. American Indians and Alaska Natives (AI/AN) have high rates of alcohol and other drug use, as well as a high incidence of unsafe sex behaviors and injection drug use practices. Indicators of AI/AN HIV risks involving sexual activity include high rates of STDs, such as gonorrhea, chlamydia, and syphilis. Despite these facts, the prevalence of HIV infection among AI/AN is not well known. The present study is part of a HRSA-funded SPNS HIV/AIDS health initiative, one goal of which is to increase the number of HIV-positive individuals who know their HIV status. To meet the goal of the SPNS project, patients in an inpatient alcohol and drug treatment center were provided with an HIV prevention educational presentation followed by one-on-one HIV counseling. Motivational interviewing was used in the counseling sessions to aid participants in recognizing their risk status and making a decision to be HIV tested. Results show that of the 134 who agreed to one-on-one HIV counseling and 105 (78%) returned for their results.

Adult↗

PubMed1998

Increases in levels of antibody to hepatitis B surface antigen in an immunized population.

Hepatitis B vaccine is effective in preventing infection with hepatitis B virus (HBV), but its duration of protection is unknown. To examine the effect of exposure to HBV on an immunized population, data were analyzed from a cohort of Alaska Natives who were immunized and then followed up annually for 10 years. A boost in antibody to hepatitis B surface antigen (anti-HBs) was defined as a fourfold rise in levels to > or = 20 mIU/mL that was not accompanied by the presence of antibody to hepatitis B core antigen or attributable to interim vaccination. During 10 years of follow-up, 8.2% of 1,595 vaccines had boosts in anti-HBs. Persons with boosts did not differ significantly from those without boosts in terms of age, gender, village, initial level of anti-HBs, or level of anti-HBs before the boost. These results underscore the continued exposure to HBV among vaccinees and the continued protection against disease that the vaccine provides.

Adolescent↗

PubMed2004

Racial/ethnic disparities in coronary heart disease risk factors among WISEWOMAN enrollees.

BACKGROUND: We used the baseline data collected for the Well-integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) participants to provide a snapshot of cardiovascular disease (CVD) risk on enrollment and to address racial/ethnic disparities in the following CVD risk factors: body mass index (BMI), systolic and diastolic blood pressure, high-density lipoprotein (HDL) and total cholesterol, diabetes and smoking prevalence, 10-year coronary heart disease (CHD) risk, and treatment and awareness of high cholesterol, hypertension, and diabetes. METHODS: We used linear regression analysis to (1) assess the presence of racial/ethnic disparities and test whether existing disparities can be explained by (2) differences in individual characteristics or by (3) differences in individual and community characteristics. RESULTS: Our results reveal a high degree of CVD risk among the WISEWOMAN participants and statistically significant racial/ethnic disparities in risk factors. Black participants were at the greatest risk of CVD, and Hispanic and Alaska Native participants were healthier in terms of CVD risk than white participants. Some racial/ethnic disparities were explained by differences in individual and community characteristics, but other disparities persisted even after controlling for these factors. CONCLUSIONS: Because differences in community characteristics explain many of the racial/ethnic disparities in CVD risk factors, eliminating disparities may require community-wide interventions. Successful WISEWOMAN projects are likely to not only reduce CVD risk factors overall but also to lessen racial/ethnic disparities in these risk factors.

Black People↗

PubMed2006

Predictors of belief that genetic test information about hemochromatosis should be shared with family members.

We queried 101,951 white, Hispanic, black, Asian, American Indian (i.e., American Indian or Alaska Native in the United States and North American Indian, Metis, or Inuit in Canada) and Pacific Islander (including Native Hawaiian) adults who agreed to be genotypically and phenotypically screened for hemochromatosis as part of the Hemochromatosis and Iron Overload Screening (HEIRS) study about their views on sharing genetic test information with family members. Multiple logistic regression (adjusting for study site, age group, race/ethnicity, preferred language, gender, education group, income group, SF-36 General Health and Mental Health subscales, perceived benefits and limitations of genetic testing, and belief that genetic testing is a good idea) evaluated independent predictors of responding "Strongly Agree" or "Agree" versus "Disagree" or "Strongly Disagree" to the statement "Information about a person's genetic risk should be shared with family members". Agreement that genetic risk information should be shared with family members was high (93% in the overall sample of 78,952 who answered this question), but differed among racial/ethnic groups. Hispanics were significantly less likely to agree that genetic test information should be shared with family members (i.e., 88% versus 92% or more among all other ethnicities). The relationship of perceived limitations and benefits of testing, gender, and age group to the belief that information should be shared differed among racial/ethnic groups, with Spanish-preferring Hispanics being the most different from other subgroups.

Cross-Cultural Comparison↗

PubMed1995

Data sources for aging research on racial and ethnic groups.

This article reports the results of a survey of recent and ongoing aging-related data sources supported by U.S. federal agencies. The survey sought to obtain data on the sample sizes and topics covered within the data sets maintained and frequently used by the various federal agencies engaged in data collection and/or analysis. The objective of the study was to determine the suitability of these data sets to conduct research on minority elders. Formal tests of the adequacy of data set sample sizes to support analysis on various minority groups were performed. Each data set was found to be large enough to conduct research on white elders, and a majority of the data sets were large enough for research on African American elders. However, Hispanics, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders were rarely included in sufficient numbers.

Aged↗

PubMed1997

Rationale, design and methodology for the Navajo Health and Nutrition Survey.

As recently as 1990, there was no reservation-wide, population-based health status information about Navajo Indians. To remedy this shortcoming, the Navajo Health and Nutrition Survey was conducted from 1991 to 1992 to assess the health and nutritional status of Navajo Reservation residents using a population-based sample. Using a three-stage design, a representative sample of reservation households was selected for inclusion. All members of selected households 12 y of age and older were invited to participate. A total of 985 people in 459 households participated in the study. Survey protocols were modeled on those of previous national surveys and included a standard blood chemistry profile, complete blood count, oral glucose tolerance test, blood pressure, anthropometric measurements, a single 24-h dietary recall and a questionnaire on health behaviors. The findings from this survey, reported in the accompanying papers, inform efforts to prevent and control chronic disease among the Navajo. Lessons learned from this survey may be of interest to those conducting similar surveys in other American Indian and Alaska Native populations.

Adolescent↗

PubMed1988

The epidemiology of AIDS in Asian and Pacific Islander populations in San Francisco.

To evaluate the epidemiology of HIV infection in Asian and Pacific Islander populations in San Francisco, we compared cases of AIDS reported in Asians and Pacific Islanders with those reported in other racial and ethnic groups. The incidence of AIDS in Asians and Pacific Islanders was significantly lower than in Whites, Blacks, Latinos and American Indians and Alaska natives. AIDS cases among Asians and Pacific Islanders have increased 177% since 1985 compared with 54% in other racial and ethnic groups, with the greatest increase in homosexual and bisexual men and transfusion recipients. Among Asian and Pacific Islander ethnic groups, the incidence of AIDS was 168 cases per 100,000 in Polynesians, 141 per 100,000 in Japanese, 92 per 100,000 in 100 Filipinos, 72 per 100,000 in southeast Asians, and 21 per 100,000 in Chinese. We conclude that AIDS cases are disproportionately increasing in Asians and Pacific Islanders in San Francisco.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Environmental assessment of the Indian health service.

The Indian Health Service (IHS), an agency within the U.S. Department of Health and Human Services, was responsible for providing federal health services to 1.51 million American Indian and Alaska Natives in 2000. Several opportunities related to health care exist for the IHS: potential public and private collaborations, continuation of the Clinton Administration's legacy of meaningful tribal consultation, and increasing the numbers of American Indian physicians, nurses, and other health related professionals. Modifications in federal programs such as Medicare and Medicaid pose a serious threat to the IHS because the IHS relies on these programs to offset the overall lack of funding. This article provides a framework for identifying the ways in which the external environment affects and determines the IHS' strategic responses to ensure competitiveness within the U.S. health care market. Value chain analysis will be used to evaluate the competitive advantages and disadvantages of the current IHS internal environment.

Economic Competition↗

PubMed1996

Substance abuse treatment of American Indian adolescents: comorbid symptomatology, gender differences, and treatment patterns.

OBJECTIVE: To describe the patient population and use of mental health treatment at a residential substance abuse treatment program for American Indian and Alaska Native adolescents. Specifically, this article (1) reports the level of psychiatric symptomatology among the patient population; (2) compares male and female patients in terms of demographics, symptomatology, and receipt of mental health treatment; and (3) examines the degree of association between patient psychiatric symptomatology and the receipt of mental health treatment. METHOD: Medical records were reviewed for all 64 patients admitted over a 1-year period. Data included patient characteristics such as substance use and psychiatric symptomatology as well as the receipt of mental health treatment. RESULTS: Sixty-eight percent of patients screened positive for at least one psychiatric symptom type. Females reported greater substance use and were more likely to report that they were victims of abuse. Females also were more likely than males to receive mental health treatment even though males had at least equal need. Finally, there was no significant relationship between measures of psychopathology and subsequent receipt of mental health treatment. CONCLUSIONS: Reassessment of the methods for identifying and treating patients with comorbid psychopathology within programs of this nature is indicated.

Adolescent↗

PubMed1998

Immune responses of prematurely born infants to hepatitis B vaccination: results through three years of age.

BACKGROUND: Hepatitis B vaccine is effective in infants. Preterm infants also respond but information on long term immunogenicity is limited. PURPOSE OF STUDY: To compare response of premature and full term infants to hepatitis B vaccine. METHODS: Sixty-nine prematurely born Alaska Native infants received three doses of hepatitis B vaccine beginning at discharge. Thirty-seven infants had paired serum samples drawn at approximately 1 and 3 years of life which were tested for antibody to hepatitis B surface antigen. One hundred eight infants born at full term enrolled in a separate study were used for comparison. RESULTS: Both early and late blood sample antibody to hepatitis B surface antigen titers were lower in preterm than in term infants (23.1 mIU/ml vs. 56.8 mIU/ml, early blood sample; and 0.7 mIU/ml vs. 1.32 mIU/ml, late blood sample); however, these values were not statistically different. The drop in titer over time, however, was significant in both groups as was the decrease in the percent of infants with titers > or = 10 mIU/ml (preterm infants 75.7% early specimen and 8.1% late specimen compared with term infants 87% early specimen and 15% late specimen). Both prematurity and longer interval between third vaccination and blood sample were associated with a decreased antibody titer. No infant had evidence of hepatitis B viral infection by developing antibody to hepatitis B core antigen. CONCLUSIONS: Preterm and term infants have a similar decline in antibody titers during the first 3 years, but preterm infants generally have a lower titer. The immunogenicity of the vaccine beyond 3 years and the need for revaccination in these populations requires further study.

Child, Preschool↗

PubMed2003

Journeys of the Circle: a culturally congruent life skills intervention for adolescent Indian drinking.

There has been an increasing call for and development of culturally appropriate substance prevention/intervention for ethnic minorities in schools and communities, especially among reservation and in urban American Indian and Alaska Native (AIAN) communities. Past attempts to intervene in and reduce misuse of alcohol and other drugs have not had great success. The Journeys of the Circle Project utilized innovative programs with a strong emphasis on historic cultural traditions.

Adaptation, Psychological↗

PubMed2005

Adherence to guidelines for follow-up of low-grade cytologic abnormalities among medically underserved women.

OBJECTIVE: To determine whether women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) who had findings on a Papanicolaou (Pap) test of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) were followed up in accordance with the interim guidelines for management of abnormal cervical cytology. METHODS: For this study period, the guidelines for a Pap result of ASC-US or LSIL specified follow-up by Pap tests repeated every 4 to 6 months for 2 years. If a second report of ASC-US or LSIL was made, the patient was to have colposcopy. We analyzed data from 10,004 women who had a result of ASC-US or LSIL followed by a second ASC-US or LSIL from 1991-2000. RESULTS: As judged by the guidelines, 44% of women who had 2 low-grade abnormalities were followed up appropriately with colposcopy. Among women with 2 ASC-US results, those aged less than 30 years were more likely to receive colposcopy than the other age groups, while women who were aged 60 years and older were more likely to be followed up with a third Pap test. For each of the 4 result groups, American Indian or Alaska Native women had the highest percentages of a third Pap test, whereas Black or African-American women had a higher percentage of no follow-up. CONCLUSION: More than one half of the women studied were not followed up in accordance with the established guidelines for managing abnormal cervical cytology. Factors such as age and race or ethnicity influence whether women with cytologic abnormalities receive appropriate follow-up.

Adult↗

PubMed1996

Walking the journey of womanhood: Yakama Indian women and Papanicolaou (Pap) test screening.

Cervical cancer is the second leading cancer among Alaska Native, American Indian women, who have a high incidence of cervical cancer and low survival rates (Boss, 1991; Michalek & Mahoney, 1990; Page & Asire, 1985). The purpose of this Grounded Theory study was to gain a greater understanding of the meaning of the papanicolaou (Pap) test to the Yakama Indian women of eastern Washington to support the Tribe in the design of effective screening interventions. Data from 15 interviews, focus groups, and participant observation were included in the data analysis. The major theme was: Walking the Journey of Womanhood. Four phases of the journey were identified: (a) Starting the Journey, (b) Blooming, (c) Heading the Household, and (d) Becoming an Elder. In this study we found that interventions to influence Pap test screening among the Yakama women must address structures of care, provider-patient communications, and education for the women. Women heading the households and elders were identified as priority populations for education because they have negative attitudes from previous experiences and have a great influence on the younger women. Messages need to be wellness oriented and traditional methods of education, such as the talking circle, role model, and storytelling, need to be used.

Adult↗

PubMed2000

The IHS dental program--a historical perspective.

The federal government provides health services for American Indians and Alaska Natives based on treaties with tribes, legislation, and executive orders. These services began in the late 1700s, when they were the responsibility of the Department of War. This responsibility was later transferred to the Bureau of Indian Affairs and in 1955 the Indian Health Service was established within the United States Public Health Service. This paper describes the development and mission of the Indian Health Service dental program. During the 1950s, Public Health Service officers were assigned to the dental program, dental assistant training centers were established, and clinical prevention programs were implemented. Increased dentist recruitment, the implementation of four-handed dentistry, and the development of an automated information system were the highlights of the 1960s. Considerable effort was placed on work force development during the 1970s, while expansions of both treatment and prevention services were the highlights of the 1980s. Unfortunately, decreases in administrative staffing and a decline in clinical services have been noted during the last decade. The main reasons for the decline were initiatives to reduce the size of federal government and inability to recruit and retain dentists in clinical positions. Also, many tribes have elected to manage their own programs and have requested and received their share of IHS administrative funds to use in their programs. Recent pay and budget legislation along with changes in program management should reverse this trend.

Dental Health Services↗