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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↗
PubMed2001

Gender and reported health problems in treated alcohol dependent Alaska natives.

OBJECTIVE: An ongoing study of phenotypes of alcohol dependence among Alaska Natives provides the opportunity to investigate gender differences in reported health-related problems among alcohol dependent clients in three residential programs in Anchorage, Alaska. METHOD: Clinical assessment information was obtained on 469 (263 male) subjects from consecutive admissions to each of three treatment programs. The average (SD) age of the sample was 33.7 (8.4) years. Patterns of substance use, comorbid psychopathology, overall health status, alcohol and other drug withdrawal symptoms, and psychological and physical consequences of alcohol and other drug use were examined. RESULTS: Male and female subjects reported similar experiences with alcohol-related health problems, including symptoms of withdrawal and the psychological and physical consequences of chronic alcohol abuse. However, women were significantly more likely to have lifetime diagnoses of major depression and cocaine dependence, whereas men were more likely to have lifetime diagnoses of antisocial personality disorder and marijuana dependence. Women reported a lower overall health status, more medication use and pain complaints, and more negative consequences of cocaine abuse and withdrawal than did men. CONCLUSIONS: Both men and women within this sample of inpatient alcohol-dependent Alaska Natives were found to have a similar early onset and rapid progression to DSM-III-R alcohol dependence, and to report a similar prevalence of alcohol-related psychological and physical problems. Reports by women of more pain symptoms, more medication use and more negative health consequences related to their cocaine abuse, compared with men in this alcohol dependent sample, suggests additional considerations for treatment planning and intervention.

Adolescent↗
PubMed2004

Intimate partner violence in American Indian and/or Alaska Native communities: a social ecological framework of determinants and interventions.

This essay synthesizes the research on intimate partner violence (IPV) in American Indian and/or Alaska Native communities using a social ecological framework. The review of literature demonstrates that American Indian and/or Alaska Native women are at an elevated risk for IPV compared to non-American Indian women and thus this essay describes multi-level interventions that are culturally appropriate for American Indian and/or Alaska Native communities. The interventions address a variety of determinants including gender, age, socioeconomic status, alcohol, European colonization, and infrastructure.

Adolescent↗
PubMed1992

American Indian--Alaska Native youth health.

OBJECTIVE: To assess risk behaviors, health problems, worries and concerns, and resiliency-promoting factors among American Indian-Alaska Native adolescents. DESIGN: Survey. SETTING: Nonurban schools from eight Indian Health Service areas. PARTICIPANTS: A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES: revised version of the Adolescent Health Survey, a comprehensive, anonymous, self-report questionnaire with 162 items addressing 10 dimensions of health. RESULTS: Poor physical health was reported by 2% of the study sample and was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies. Injury risk behaviors included never wearing seatbelts (44%), drinking and driving (37.9% of driving 10th through 12th graders), and riding with a driver who had been drinking (21.8%). Physical and sexual abuse prevalence was 10% and 13%, respectively, with 23.9% of females reporting physical abuse and 21.6% of females reporting sexual abuse by the 12th grade. Almost 6% of the entire sample endorsed signs of severe emotional distress. Eleven percent of the teens surveyed knew someone who had killed himself or herself, and 17% had attempted suicide themselves. Sixty-five percent of males and 56.8% of females reported having had intercourse by the 12th grade. Weekly or more frequent alcohol use rose from 8.2% of seventh graders to 14.1% by the 12th grade; for males, the survey noted an increase in regular alcohol use of 3% to 5% a year to 27.3% by the 12th grade. For each variable measured, rates are much higher for American Indian adolescents than those for rural white Minnesota youth, except for age at first intercourse and alcohol use. CONCLUSIONS: American Indian-Alaska Native adolescents reported high rates of health-compromising behaviors and risk factors related to unintentional injury, substance use, poor self-assessed health status, emotional distress, and suicide. Interventions must be culturally sensitive, acknowledge the heterogeneity of Indian populations, be grounded in cultural traditions that promote health, and be developed with full participation of the involved communities.

Adolescent↗
PubMed1990

Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers.

A total 1400 hepatitis B surface antigen-positive Alaska natives, 824 men and 576 women of all ages, were followed up prospectively over a period of 7815 carrier years for the development of sequelae related to chronic hepatitis B virus infection. During the observation period, 20 cases of hepatocellular carcinoma, 14 cases of chronic active hepatitis, 8 cases of cirrhosis, and 1 case of glomerulonephritis developed in this cohort. The annual incidence of hepatocellular carcinoma was 387 per 100,000 for men and 63 per 100,000 for women. The incidence of chronic active hepatitis and cirrhosis was 193 and 107 per 100,000 in men and 158 and 95 per 100,000 in women, respectively. No cases of either essential mixed cryoglobulinemia or necrotizing vasculitis were seen. Sixty of the hepatitis B surface antigen-positive carriers died, with 13 (21.7%) of the deaths due to hepatocellular carcinoma. The leading cause of death in this group was malignant neoplasms compared with accidents in the general Alaska native population.

Adolescent↗
PubMed2003

Health risk-factors for gay American Indian and Alaska Native adolescent males.

Having multiple identities as a homosexual American Indian or Alaska Native adolescent male increases the likelihood for poorer health and diminished well-being. This study assessed the differences in self-perceived health status between gay adolescent males and their heterosexual counterparts. A national nonrepresentative sample of 5,602 Indian and Native adolescent males was surveyed about issues of sexual behavior, physical and sexual abuse, mental health status, substance use, attitudes about school, participation in violence, and access to health care. Results indicate that there were no real differences between gay and heterosexual male respondents for substance use or attitudes about school. Statistically significant differences were found, however, in areas of mental health, as well as physical and sexual abuse. Gay adolescents were twice as likely to have thought of or attempted suicide. Gay adolescents were twice as likely to have been physically abused and nearly six times more likely to have been sexually abused. Gay American Indian or Alaska Native adolescent males constitute a very vulnerable population and are clearly in need of targeted health and social services. Unfortunately, the benefits seen by adults of the "two-spirited" gay and lesbian American Indian movement have not been accessible to Indian and Native adolescents.

Adaptation, Psychological↗
PubMed2001

The Alaska Native diabetes program.

OBJECTIVES: To provide optimum health care to indigenous people with diabetes, to prevent diabetes, and to monitor the epidemiology of diabetes and selected complications. The purposes of this paper are to describe the program and to present data that highlights the major problems and successes. STUDY DESIGN: Descriptive epidemiology report of diabetes and population service program based on yearly chart review data. METHODS: Almost half of Alaska Natives with diabetes have no direct access to physicians or hospitals. Health care delivery is now managed by the tribes themselves. Program emphases include maintenance of a population-based registry, formal training for village health aides, physical activity programs, patient education, primary prevention activities and adherence to standards of care to prevent complications. A centralized registry is maintained to assure that epidemiological data is available and patients are not lost to follow-up. Each year a random sample of charts at each major facility is audited against nationally standardized care guidelines. RESULTS: The prevalence of diabetes among Alaska Natives increased 80% over the 13 years from 1985 to 1998 (15.7/1000 to 28.3/1000, age adjusted to U.S. 1980 population). For the years 1986-1998 the incidence rates of lower extremity amputation and end stage renal disease were 6.1/1000 and 2.0/1000 respectively. The level of care provided to Alaska Native patients is comparable to that provided to the general diabetic patient population seen in Alaskan urban clinics. CONCLUSIONS: In spite of logistic challenges, care provided to Alaska Native people with diabetes compares favorably to that provided in other settings. Incidence rates of lower extremity amputation and end stage renal disease also remain comparable to or lower than those in other U.S. populations. Many aspects of our system could be extended to other chronic disease programs serving isolated indigenous populations. Primary prevention of diabetes remains a major challenge as life styles change.

Alaska↗
PubMed1989

Ethnicity of socioeconomic status? Health differences between elder Alaska Natives and whites.

We investigated self-reported health difference between elderly Alaska Natives and whites, and attempted to distinguish the effects of socioeconomic factors from other facets of ethnicity, upon health and physical well-being. Results indicate that elderly Alaska Natives suffer from a greater variety of impairments than do whites. Health differences disappear, however, in multivariate analyses that control for socioeconomic factors. Income, education, gender, and age appear to be more important determinants of health status among the elderly than ethnicity, per se.

Aged↗
PubMed1996

American Indians and Alaska Natives--overview of the population.

THE ESTIMATED TWO MILLION American Indians and Alaska Natives, while sharing certain genetic traits, belong to groups with distinct social, cultural, political, and biomedical attributes. They share with certain other ethnic minorities high poverty rates, low educational attainment, increased susceptibility to certain diseases, and elevated mortality rates. Hypertension has been reported less frequently among American Indians compared to other U.S. groups, but is increasing in frequency, is strongly associated with obesity and diabetes, and is synergistically associated with diabetes in the etiology of end-stage renal disease. The first priority for dealing with hypertension among American Indians is to maximize efforts toward control. The Indian Health Service (IHS) provides such an opportunity, which is not as readily available to other minorities. In addition to controlling hypertension, areas of fruitful investigation include studies relating hypertension to acculturation, physiology of peripheral adrenergic vasoreceptors, salt and water metabolism, and prevention or amelioration of end-stage renal disease. Understanding some of these basic processes will prove valuable for American Indians and Alaska Natives as well as the entire population.

Alaska↗
PubMed2005

Development, adaptation, and implementation of a cardiovascular health program for Alaska native women.

Southcentral Foundation's Traditions of the Heart program is an innovative cardiovascular disease prevention program for women designed to build on the strengths of the Alaska Native culture as a way to support and encourage positive lifestyle behaviors that focus on healthy eating, active living, stress management, and tobacco cessation. After conducting assessments of existing intervention programs and formative data collection, we adapted two existing programs, Native Nutrition Circles and A New Leaf... Choices for Healthy Living, to develop the Traditions of the Heart program. We implemented and evaluated a pilot intervention study to determine the program's acceptance among Alaska Native women. We used the evaluation results to further refine our study protocol. This article describes the adaptation of these programs to the cultural needs and strengths of Alaska Native women and the results of the formative evaluation used to improve the program design. The complete pilot study outcomes will be published separately.

Alaska↗
PubMed1997

Seasonal differences in suicide birth rate in Alaska Natives compared to other populations.

Seasonal differences in suicide birth rates among Alaska Natives and for populations at different latitudes (residents of the Yukon, Saskatchewan, Montana, Wyoming, and Pennsylvania) were investigated. Seasonal birth rates for the general population were similarly examined. Suicide birth rates showed small seasonal variations for Alaska Natives with summer births showing more suicides. However, at lower latitudes, suicide birth rates among other populations showed no seasonal differences. Hours of daily sunlight at the summer and winter solstice correlated with the proportion of suicide victims born during those seasons. Seasonal differences in birth rates of suicide victims correlated strongly with latitude and seasonal differences in daylight. General population birth rates did not show significant seasonal differences, and did not correlate with differences in latitude or sunlight length at the summer or winter solstice.

Alaska↗
PubMed2003

Post-operative deepvein thrombosis is infrequent in Alaska Natives.

OBJECTIVES: The expected rate of deep vein thrombosis (DVT) after laparotomy or major joint surgery has been reported to be 20 to 50% for unprophylaxed non-native patients. DVT prophylaxis for surgical patients at the Alaska native Medical Center has typically not been offered as the perceived rate of DVT and pulmonary embolism in our patient population has been very low. Retrospective analysis of positive venous duplex scans at our institution revealed only four cases of post-operative DVT during a two-year interval. This study was designed to document the actual rate of post-operative DVT in Alaskan natives not provided with routine DVT prophylaxis. STUDY DESIGN: Prospective cohort study of DVT in open abdominal, open knee, open hip and pelvic fracture surgery patients at the Alaska native Medical Center from 1999-2001. METHODS: The day prior to expected discharge, we performed venous duplex ultrasonography on 67 patients with open abdominal surgery, major open knee or hip surgery, or pelvic fracture who received no DVT prophylaxis. Some patients included in the study were also asked questions about their consumption of marine mammals and fish, and the native blood quanta was estimated in all patients using existing data bases. RESULTS: Sixty percent of the study population was determined to be at high risk for DVT using standard risk stratification methods. Dietary habits varied widely, but were largely reported as being "traditionally" native. Nearly all patients had 50% or more "native blood". Only one of 67 patients developed a documented post-operative DVT. CONCLUSIONS: Post-operative deep vein thrombosis in Alaskan natives not provided with routine DVT prophylaxis is rare. The data does not provide a clear indication as to why Alaskan natives may be at decreased risk for post-operative DVT.

Adult↗
PubMed1990

High incidence of sudden infant death syndrome among northern Indians and Alaska natives compared with southwestern Indians: possible role of smoking.

Epidemiologic studies of sudden infant death syndrome (SIDS) in the United States have found a particularly high incidence among American Indians and Alaska Natives compared with whites. This report shows that there is a remarkable difference in the incidence of SIDS between Northern Indians and Southwestern Indians. From 1984 through 1986, the incidence of SIDS was 4.6 per 1,000 live births among Indians and Alaska Natives in the Northern region of the United States, while the incidence among Southwestern Indians was 1.4 per 1,000 live births (risk ratio = 3.4; 95 percent confidence interval = 2.4-4.8). Among whites living in the same regions, the incidence of SIDS was 2.1 and 1.6 per 1,000 live births, respectively. The incidence among Native Americans in the Northern region was high in all five Indian Health Service Areas. Differences in socioeconomic status, maternal age, birth weight, and prenatal care did not appear to explain the higher incidence of SIDS among Northern Indians compared with Southwestern Indians. However, the prevalence of maternal cigarette smoking during pregnancy is exceptionally high among Northern Indians and Alaska Natives, while it is low among Southwestern Indians. This difference in smoking habits may explain, at least in part, the excess risk of SIDS among Indians in the Northern region. This report points to the need for effective smoking cessation programs for Native Americans, targeting in particular women of reproductive age.

Alaska↗
PubMed1987

Psychiatric assessment and treatment of American Indians and Alaska Natives.

It is widely recognized that the cultural uniqueness of American Indians and Alaska Natives must be reflected in the methods of diagnosing and treating their mental health problems, but empirical validation of specific diagnostic instruments and treatment has been slow in coming. The authors' literature review indicates that many standardized self-rating scales and interview schedules can accurately assess mental illness among Indians, provided they are modified to reflect cultural heritage and experiences. Group therapy is increasingly chosen as a psychiatric treatment for American Indians, as are family-network therapy and several traditional Indian therapies. The authors also review the demographics and psychiatric epidemiology of American Indians and Alaska Natives.

Alaska↗
PubMed1998

Immunogenicity of a combined hepatitis B and Haemophilus influenzae type b conjugate vaccine in Alaska Native infants.

UNLABELLED: Hepatitis B and Haemophilus influenzae b (Hib), prevalent diseases in Alaska Native infants, have been reduced 95% following universal vaccination. Therefore, we were interested in studying a new combined Hib and hepatitis B vaccine in this population. METHOD: Healthy Alaska Native infants free from Hib and hepatitis B exposure were randomized into four groups, three with different lots of bivalent Hib and hepatitis B vaccine, and one with Hib and hepatitis B monovalent controls. The Hib component had 7.5 micrograms of polyribosylribitol phosphate polysaccharide (PRP) bound to 125 micrograms of Neisseria meningitidis outer membrane protein complex (OMP); the hepatitis B component was 5 micrograms of recombinant hepatitis B surface antigen. The vaccines were given at 2 months, 4 months, and 12-15 months of age. RESULTS: There were no differences in the responses to the bivalent compared to the monovalent controls except for a lower Hib anti-PRP level at 12-15 months in the bivalent recipients; this did not persist after the booster. CONCLUSION: A combined Hib and hepatitis B vaccine appears immunogenic. The recommended schedule for the Hib component (PRP-OMP) of 2 months, 4 months, and 12-15 months appears to promote an optimal response to the hepatitis B component as well.

Alaska↗
PubMed1998

Alaska Native cancer epidemiology in the Arctic.

Cancer incidence and its possible relation to environmental contaminants, including radiation, continues to be a perceived health threat for the arctic-dwelling Alaska Native (Inupiat Eskimo) people despite the lack of a direct link to high-dose exposure. To better understand this concern, all known malignancies diagnosed in this population (n = 177) in three consecutive eight-year periods (1971-1994) were evaluated. The most recent average incidence rate (age-adjusted to world standard population) of 315 per 100,000 (95% confidence interval, CI = 248-382) represents a 33% surge (albeit non-significant) in Alaska Native cancer incidence over the initial period studied. The male rate 366 (95% CI = 266-466) for the same period exceeds the female rate 258 (95% CI = 169-347) by 42%. Two patterns of cancer incidence are seen at the village level. One, a 24 y upward trend found in the villages of Barrow, Point Hope and Kaktovik (combined rate of increase significant [P = 0.047]) associated with lung cancer; and the other, a stable trend over the past 16 y, associated with colon and rectal cancer. Lung cancer is the predominant cancer by site and is primarily a male disease. The recent male lung cancer incidence rate of 137 (95% CI = 73-201) exceeds the female rate by greater than five times. Total lung cancer cases are primarily confined to four villages where the incidence significantly (P = 0.0043) exceeds the remaining population. The major female cancers are colon/rectal and breast with cancer of the cervix virtually eliminated. Breast cancer is found primarily in two villages where its excess is significant (P = 0.025). Inupiat Eskimo cancer epidemiology is unique, differing from both the Alaska Native and other Circumpolar populations. At present, this uniqueness cannot be explained by an overt environmental contaminant exposure. Although tobacco very likely plays a central role, it by itself cannot fully explain the extremely high male lung cancer rate and why only specific villages are affected. Genetic predisposition and environmental factors may play a synergistic role as cofactors. A cooperative investigative effort with the Inupiat population is indicated and may go a long way in reducing cancer concern in the region.

Adolescent↗
PubMed1997

The psychological repercussions of the sociocultural oppression of Alaska Native peoples.

Issues of the mental health of arctic and subarctic Alaska Natives are explored. Their sociopolitical history is described to familiarize psychologists with the special circumstances of several groups of peoples in Alaska that have been ignored in psychological literature. This history demonstrates how intervention by European Americans in Alaska has prompted a self-alienation of Native peoples that has contributed to exorbitant suicide rates, increasing levels of addiction, high rates of interpersonal violence, and high teenage pregnancy. These developments are contrasted with traditional lifestyles. Recommendations are made about the role of psychology in the facilitation of the recovery process of Alaska Native peoples.

Acculturation↗
PubMed1996

Nutrition and cancer among American Indians and Alaska Natives.

BACKGROUND: More than a third of all cancers in the United States are thought to be attributable to various nutritional factors, and major changes in nutrition have been experienced by American Indians and Alaska Natives in the past century. METHODS: The published literature was reviewed to summarize the relationship between diet and cancer, to summarize what is known about the past and current diet of American Indians and Alaska Natives, and to consider whether nutrition might play a role in their current or future risk of cancer. RESULTS: Epidemiologic studies show a consistent pattern of lower risk for cancers of the colon and lung among those who eat larger amounts of fruits and vegetables and higher risk for cancers of the colon and prostate for those who eat larger amounts of fat. Limited data indicate that the diets of American Indians and Alaska natives are similar to the current average American diet, that is, high in fat and low in fruits and vegetables. CONCLUSIONS: Diet is an important factor for several major cancers. Although the cancer rates among many Native American groups are currently lower than among non-native Americans, they seem to be increasing. Cancer rates among Native Alaskans are already much higher than for non-native Americans. Nutrition-related cancers are likely to increase in the future among Native Americans as a result of past changes in diet. However, Native Americans may have a stronger cultural basis than do non-native Americans to adopt traditional principles of the value of good foods and physical activity to achieve future nutritional improvements to reduce cancer risk.

Alaska↗