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PubMed2001

Trends in infectious disease hospitalizations among American Indians and Alaska Natives.

OBJECTIVES: This study sought to describe trends in hospitalizations associated with infectious diseases among American Indians and Alaska Natives. METHODS: Infectious disease hospitalizations and rates among American Indians and Alaska Natives from 1980 through 1994 were examined via Indian Health Service hospital discharge data and compared with published trends for the general US population. RESULTS: Annual hospitalization rates for infectious diseases among American Indians and Alaska Natives decreased by 31.0% between 1980 and 1994. Infectious disease hospitalizations accounted for 16.3% of all hospitalizations in 1980 and 21.2% in 1994, an increase of 30.1%. In 1994, the age-adjusted infectious disease hospitalization rate for American Indians and Alaska Natives was 1863 per 100,000 population, approximately 21% greater than that for the general US population. CONCLUSIONS: Hospitalization trends for infectious diseases show that there has been improvement in the health status of American Indians and Alaska Natives but also indicate that this population has a higher infectious disease burden than the general US population.

Adolescent↗
PubMed1995

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↗
PubMed1998

Preventing deaths in Alaska's commercial fishing industry.

BACKGROUND AND PURPOSE: The arctic and sub-arctic waters of Alaska provide a very hazardous work setting, with special hazards posed by great distances, seasonal darkness, cold waters, high winds, brief fishing seasons, and icing. Our intent is to reduce the remarkably high occupational fatality rate (200/100,000/year in 1991-1992) among Alaska's commercial fishing workers. Over 90% of these deaths have been due to drowning or drowning plus hypothermia, primarily associated with vessel capsizings and sinkings. METHODS: Comprehensive surveillance for commercial fishing occupational fatalities was established during 1991 in Alaska. During 1990 through 1994, the U.S. Commercial Fishing Industry Vessel Safety Act of 1988 required the implementation of comprehensive prevention measures for all fishing vessels in offshore cold waters, including immersion suits and other personal flotation devices, survival craft (life rafts), emergency position-indicating radio beacons, and crew training in emergency response and first aid. Parallel to this, voluntary training efforts by nonprofit organizations have greatly increased. RESULTS: During 1990-1994, drowning was the leading cause of occupational death in Alaska. During this period, 117 fishers died, 101 of them from drowning or drowning/hypothermia. During 1991-1994, there was a substantial decrease in Alaskan commercial fishing-related deaths, from 34 in 1991 to 35 in 1992, 22 in 1993, and 10 in 1994. While man-overboard drownings and some other categories of deaths (falls, fires) have continued to occur, the most marked progress has been in vessel-related events. CONCLUSION: Specific measures tailored to prevent drowning in vessel capsizings and sinkings in Alaska's commercial fishing industry have been very successful so far. Additional efforts must be made to reduce the frequency of vessel events and to prevent man-overboard events and drownings associated with them.

Accidents, Occupational↗
PubMedDate not supplied

Risk factors for osteoporosis in Alaska Native women: a cross-sectional survey.

OBJECTIVES: To estimate the prevalence of risk factors for osteoporosis in Alaska Native (AN) women and to assess the feasibility of portable bone density measurement in rural Alaska. METHODS: We conducted a cross-sectional survey of a convenience sample of 452 patients from 17 clinics in Alaska. We interviewed subjects regarding risk factors for osteoporosis and measured calcaneal bone density by ultrasound. RESULTS: Of the 452 women, 316 (70%) were Alaska Natives. Risk factors for osteoporosis were common among study participants. Total dietary calcium intake was low (mean = 306 mg/day). Current smokers [Odds Ratio (OR) = 3.9, 95% Confidence Interval (95% C.I.) 1.8, 8.4], former smokers (OR = 2.8, 95% C.I. 1.3, 6.2) and chronic users of oral steroids (OR = 4.7, 95% C.I. 1.8, 12.0) were at increased risk for low bone density. CONCLUSIONS: Reduction of cigarette smoking, increase in dietary calcium, and reduction of oral steroid use would likely decrease the prevalence of osteoporosis in AN women. A comprehensive prevention program including bone density screening is warranted in rural Alaska.

Absorptiometry, Photon↗
PubMedDate not supplied

The financial burden of injury-related hospitalizations to an Alaska Native health system.

The injury death rate in Alaska for American Indians and Alaska Natives is more than triple the injury death rate for the United States. We examined the direct medical expenditures for injury-related hospitalizations to one Alaska Native health care system, the Tanana Chiefs Conference in Interior Alaska, to identify priorities for injury prevention and to promote efforts at prevention. The total expenditure for the 511 injuries resulting in hospitalizations from 1994-1998 was $4,145,440. Suicide attempts, falls, and acts of violence were the most frequent causes of injury hospitalization. Injuries caused by acts of violence, suicide attempts, and falls had the highest overall expenditures. On a per-victim basis, unintentional injuries involving the use of firearms and snowmobile/all-terrain vehicle injuries were the most expensive. We hope this report will raise the visibility of injuries as a prevention priority for Alaska Native communities, Native health systems, and community action programs.

Accidental Falls↗
PubMed2003

Vaccination coverage levels among Alaska Native children aged 19-35 months--National Immunization Survey, United States, 2000-2001.

In 2000, a total of 118,846 persons indicated that their race/ethnicity was Alaska Native (AN), either alone or in combination with one or more other racial/ethnic groups. AN groups comprise 19% of the population of Alaska and 0.4% of the total U.S. population. The AN grouping includes Eskimos, Aleuts, and Alaska Indians (members of the Alaska Athabaskan, Tlingit, Haida, or other AN tribes). Eskimo represented the largest AN tribal grouping, followed by Tlingit/Haida, Alaska Athabascan, and Aleut. Vaccination coverage levels among AN children have not been reported previously. This report presents data from the National Immunization Survey (NIS) for 2000-2001, which indicate that vaccination coverage levels among AN children aged 19-35 months exceeded the national health objective for 2010 (objective no. 14-22) for the majority of vaccines. This achievement indicates the effectiveness of using multiple strategies to increase vaccination coverage. Similar efforts might increase vaccination coverage in other rural regions with American Indian (AI)/AN populations.

Alaska↗
PubMed2003

Tuberculosis contact investigations in rural Alaska: a unique challenge.

Alaska Natives suffered extraordinary rates of disease and death from tuberculosis (TB) during the first half of the 20th century. Although the epidemic was largely controlled in the 1960s, rates of TB among Alaska Natives remain higher than for other Alaskans, and village outbreaks of TB continue to pose major threats. In 2000, a contact investigation around a case patient with infectious TB involved eight villages in south-western Alaska and found 26 additional persons with TB disease and 48 people with newly positive TB skin tests. Rural Alaska brings unique challenges to TB contact investigations not seen elsewhere in the United States because many villages are accessible only by small aircraft or boat. To conduct an investigation, a public health nurse must fly into the village, bring food and water, and sleep at the village clinic or school. In spite of these obstacles, over the past 4 years contact investigations have been initiated for all TB cases with acid-fast bacilli smear-positive sputum, and the proportion of adequately examined contacts has increased from 51% to 75%. The Alaska TB Program plans to improve contact investigations through ongoing reports to regional public health centers and through a statewide training workshop.

Alaska↗
PubMedDate not supplied

Occurrence of esophageal and gastric cancer in Alaska Natives, 1969-2003.

BACKGROUND: Early reports of esophageal and gastric cancer in American Indians/Alaska Natives documented high rates. METHODS: Esophageal and gastric cancers in Alaska Natives were reviewed for 1969-2003 using the Alaska Native Tumor Registry database. Alaska Native incidence rates were age-adjusted and compared to rates of several US populations. RESULTS: The incidence of esophageal and gastric cancer has remained relatively stable during the 35-year period. Gastric cancer is higher than that seen in US Whites, Blacks and American Indians of New Mexico and similar US Asian/Pacific Islanders. Esophageal cancer incidence is higher than US Whites, Asian/Pacific Islanders and American Indians of New Mexico but similar to US Blacks. CONCLUSION: The rates of esophageal and gastric cancer in the Alaska Native population have remained high over 35 years. While the rate of gastric cancer has declined among US Whites, a similar decline has not been seen in Alaska Natives.

Alaska↗
PubMedDate not supplied

Abnormal Papanicolaou smears and colposcopic follow-up among American Indian and Alaska Native women in the Pacific northwest.

BACKGROUND: Mortality that is due to cervical cancer among American Indian and Alaska Native women in the Pacific Northwest exceeds that among women of other races. Nevertheless, little information is available regarding the prevalence and follow-up of abnormal Papanicolaou smears among American Indian and Alaska Native women in the region. METHODS: We conducted a retrospective review of medical records of American Indian and Alaska Native women seen at 12 Indian Health Service and tribally operated clinics in Washington, Oregon, and Idaho who had an abnormal Papanicolaou smear in 1992. RESULTS: Of 4547 Papanicolaou smear results reviewed, 280 (6.2 percent) had an abnormal result (dysplasia or carcinoma in situ). Of the recommended colposcopies, 167 of 224 (75 percent) were completed. Women with high-grade squamous intraepithelial lesions were more likely to obtain recommended colposcopy than were women with low-grade squamous intraepithelial lesions. Women treated at clinics that referred patients to outside providers for colposcopy were more likely to have colposcopy than were those who were offered the procedure on site. CONCLUSIONS: The proportion of Pacific Northwest American Indian and Alaska Native women in Indian Health Service and tribal clinics with abnormal Papanicolaou smears and the proportion who receive colposcopy are similar to those in other populations. The higher rate of cervical cancer mortality among American Indian and Alaska Native women could be due to failure to screen high-risk women. Cytologic screening rates, methods to improve adherence to colposcopy recommendations, and the contribution of other factors to the cause of cervical cancer mortality need to be characterized in this population.

Alaska↗
PubMed1994

Prevalence and characteristics of alcohol consumption and fetal alcohol syndrome awareness--Alaska, 1991 and 1993.

Fetal alcohol syndrome (FAS) is a leading preventable cause of birth defects and mental retardation in the United States (1). To reduce alcohol exposure to the developing fetus and to modify health-related behaviors, public health professionals and policy makers require effective methodologies to identify at-risk populations and develop strategies for preventing this problem. In Alaska, the prevalence of FAS is higher than the national average (2). Because of the need for information to assist in planning prevention programs, identifying training needs for service providers, and monitoring changes in factors related to FAS in target populations, the Alaska Department of Health and Social Services (ADHSS), the Indian Health Service (IHS), and CDC have conducted surveys to measure relevant knowledge, attitudes, beliefs, and behaviors (KABBs) in selected populations in Alaska. This report summarizes survey findings during 1991 and 1993 regarding the prevalence of alcohol consumption by and characteristics of women of childbearing age in Alaska and FAS-related KABBs in Alaska residents.

Adult↗
PubMed1993

Commercial fishing fatalities--Alaska, 1991-1992.

Based on data from the National Traumatic Occupational Fatality surveillance system, Alaska had the highest state-specific work-related fatality rate during 1980-1989. During this period, the annual average private industry fatality rate in Alaska was 34.8 per 100,000 workers, nearly five times the annual average for the United States (7.0 per 100,000) (1). Fatalities in the commercial fishing industry-which accounts for the second largest percentage of revenue and number of jobs in the state-are among the highest industry-specific rates in the United States (1). Because of the high occupational fatality rates for Alaska, in 1991, CDC's National Institute for Occupational Safety and Health (NIOSH) initiated efforts in Alaska to improve surveillance and describe risk factors for serious occupational injuries associated with the fishing, logging, and air transport industries. This report uses data obtained and analyzed by NIOSH to characterize fishing industry deaths in Alaska for 1991 and 1992.

Accidents, Occupational↗
PubMedDate not supplied

Tobacco use among Alaska youth.

The Youth Risk Behavior Survey (YRBS) is a national school-based survey used to monitor health risk behaviors that contribute to the leading causes of mortality, morbidity and social problems among youth and adults in the United States. Tobacco use is one of the behaviors monitored. Both high school and middle school surveys were administered to a representative group of Alaska high school and middle school students for the first time in 1995. Surveys were administered in a confidential and anonymous manner, taking care to assure student privacy. A total of 1,634 high school students and 1,265 middle school students completed surveys. The survey found that Alaska high school students have smoking rates higher than the national rate and that Alaska Native youth have even higher smoking rates. Furthermore, smoking is not uncommon among Alaska middle school students. Among high school students, 36.5% were current smokers (had smoked in the past 30 days) and 21.1% had smoked on 20 or more of the previous 30 days. Boys were more likely than girls to report having used chewing tobacco or snuff in the 30 days prior to the survey (23.5% of boys and 6.7% of girls). Smokeless tobacco use increased with grade level so that 29.1% of high school senior boys had used smokeless tobacco products within the previous 30 days. Over 60% of Alaska Native students reported smoking in the previous 30 days, 43.7% reported smoking 20 or more of the previous 30 days and 22.5% reported using chewing tobacco or snuff in the previous 30 days. Over half of middle school students reported having tried smoking at least once; about one-fourth smoked at least one day in the past 30 days and 5.6% smoked on 20 or more of the past 30 days.

Adolescent↗
PubMed1998

[Comparative study of epidemiology of spondylarthropathies in indigenous population of the Chukot peninsula and Alaska].

UNLABELLED: The paper sums up the many-year cooperative Russian-American studies of the epidemiology of spondylarthropathies in the arctic populations of the Chukot Peninsula and Alaska. AIM: Comparison of the epidemiology of spondylarthropathies in the indigenous population of the Chukot Peninsula and Alaska. MATERIALS AND METHODS: A universal design of investigation with the same diagnostic criteria was used in both countries. A total of 974 indigenous residents of the Chukot Peninsula were examined simultaneously, on the Alaska the sampling was formed as the residents applied for care. RESULTS: In both regions the study revealed 1) a high incidence of HLA-B27, reaching 40% in the Chukot Eskimos; 2) a similarly high incidence of spondylarthropathies varying from 2 to 3.4%; 3) a similar spectrum of diseases, including, primarily, ankylosing spondylarthritis and Reiter's syndrome and undifferentiated spondylarthropathies and (rarely) psoriatic arthritis. Among HLA-B27 positive adults, the incidence of spondylarthropathies in all groups is 4.2% and of ankylosing spondylarthritis 1.5%. CONCLUSION: A high incidence of spondylarthropathies, varying from 2 to 3.4%, was revealed in the Arctic populations of the Chukot Peninsula and Alaska with a high incidence of HLA-B27 antigen. Although the spectrum of detected diseases was similar in the two groups, ankylosing sponditis was more incident on the Chukot Peninsula, whereas on the Alaska reactive arthritis and nondifferentiated spondylarthropathies predominated, which can be explained by difference in the methods of examination.

Adolescent↗
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↗
PubMed2005

Functional limitations among older American Indians and Alaska natives: findings from the census 2000 supplementary survey.

The objectives of this study were to determine the national prevalence and profile of American Indian and Alaska Natives with functional limitations. Data were obtained from 4763 American Indian and Alaska Native respondents aged 45 years or older in the Census 2000 Supplementary Survey. Functional limitations were reported by 28% of American Indian and Alaska Natives aged 45 years or older. These individuals were poorer, older, less educated, and less likely to be married or employed than American Indian and Alaska Natives without such limitations (for all comparisons, P < .001). American Indian and Alaska Natives have high disability rates, and many are not receiving benefits for which they qualify.

Age Factors↗
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↗
PubMed1993

Immunogenicity of the 23-valent pneumococcal polysaccharide vaccine in Alaska Native chronic alcoholics compared with nonalcoholic Native and non-Native controls.

PURPOSE: This study was designed to evaluate the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine in Alaska Native chronic alcoholics and compare these responses with those in age- and sex-matched nonalcoholic, Native and non-Native control subjects. PATIENTS AND METHODS: Native alcoholic patients were recruited from the inpatient medical service and outpatient clinics. Healthy age- and sex-matched Alaska Native and non-Native nonalcoholics were recruited from hospital employees. At the initial visit, a standardized questionnaire, the Alcohol Dependency Scale, was administered to all participants. Participants were examined for liver diseases; blood was drawn for liver function tests and prevaccination pneumococcal antibody levels. Charts of all Native participants were reviewed for alcohol-related diseases. Participants received one dose of the 23-valent pneumococcal vaccine at the time of the initial visit and returned 20 to 55 days after immunization for liver function tests and pneumococcal antibody level measurement. Serotype-specific pneumococcal antibody levels were measured by radioimmunoassay. Logistic regression analysis was used to examine the proportion of persons whose serotype-specific antibody level doubled following vaccination. A model including adjustments for age, sex, and initial antibody level was used to examine the effect of alcohol status and ethnicity on response to the vaccine. Eighty-five persons completed the study. Of these, 41 were chronic alcoholics and 44 were nonalcoholic. Of these, 21 were Alaska Natives and 23 were non-Natives. RESULTS: Before vaccination, the geometric mean titers (GMTs) were similar in all 3 groups but were slightly higher in Native alcoholic participants for 11 of 12 serotypes tested. For 11 or more serotypes tested, 46% of alcoholics and 27% of nonalcoholics had total antibody levels at or above 500 nanograms of antibody nitrogen per milliliter (p = 0.11). After vaccination, the GMTs were higher in nonalcoholic than in alcoholic participants for serotypes 3, 7F, and 19F (p < 0.05). When Natives and non-Natives were compared, non-Natives had higher antibody levels than Native participants for 10 of 12 serotypes. After vaccination, 83% of alcoholics and 91% of nonalcoholics had pneumococcal antibody levels of more than 500 nanograms of antibody nitrogen per milliliter for at least 11 serotypes. When responses consisting of a twofold or greater increase in antibody level were compared, a greater proportion of nonalcoholics than alcoholics responded to serotypes 3, 4, 7F, 8, and 19F. This difference was significant for types 3 and 19F only (p < 0.05). In alcoholics there was a direct correlation between pneumococcal antibody level and age both before and after vaccination. This was significant before vaccination for serotypes 4, 6B, 18C, and 23F, and after vaccination for these types and for types 1 and 19F. In nonalcoholics there was a correlation between age and antibody response, following vaccination, for serotype 9N and 18C. Alcoholic males had antibody levels higher than that in females for most serotypes, but significantly so only for serotype 12F before vaccination, and for type 14 after vaccination. There were no sex differences seen among nonalcoholics, and no differences in response to vaccine could be detected in patients with or without liver dysfunction. CONCLUSION: In this study of Alaska Natives with chronic alcoholism, Native and non-Native participants responded adequately to immunization with the 23-valent pneumococcal vaccine, although significant differences in some serotypes were evident.

Adult↗
PubMed1995

Access to ambulatory care for American Indians and Alaska Natives; the relative importance of personal and community resources.

The debate on health care reform in the United States has been greatly influenced by various national studies showing a strong relationship between lack of public or private health care coverage and inadequate access to health services. There is also much concern about deficiencies in the availability and delivery of services to certain population groups--especially for those living in the most remote and sparsely populated areas of the country. However, national studies have generally not demonstrated that the use of health services is strongly associated with urban/rural residence or the supply of medical providers. In this study, we show that national studies can obscure the problems of certain population groups including American Indians and Alaska Natives. Using data from the 1987 National Medical Expenditure Survey, the findings show that the availability of medical providers as well as place of residence were strongly associated with the use of health care by American Indians and Alaska Natives. Although American Indians and Alaska Natives included in this study were eligible to receive health care free of charge from the Indian Health Service (IHS), financial factors were also significantly associated with use due to the use of services other than those provided or sponsored by IHS. Also, the results show that while geographic and supply factors have only modest effects on the average travel time to medical providers for the U.S. population as a whole, travel times are dramatically longer for American Indians and Alaska Natives living in rural areas and where there are few medical providers. In addition, there appear to be fewer hospitalizations in areas where there are IHS outpatient services. We conclude by discussing the need for health care reform to take into account the diversity of a large country such as the U.S., and the special needs of population groups that are usually not adequately represented in national studies.

Adult↗