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At least 19 recordsLinked to original sources
PubMed1979

Sociocultural stress and the American native in Alaska: an analysis of changing patterns of psychiatric illness and alcohol abuse among Alaska natives.

This paper presents selected morbidity and mortality statistics to outline developing trends and the current status of psychiatric illness and alcohol abuse among the Aleut, Athabascan, Yupik, Inupiat, Tlingit, Haida and Tsimpshian people of Alaska. Analysis of the records of the Indian Health Service, the Community Mental Health Centers and the Alaska Psychiatric Institute, the providers of care for Alaska Natives, shows that the number of individuals treated as inpatients and outpatients for psychiatric illness and alcohol abuse has been rising steadily. Accidental injury and suicidal behavior are common. The treated prevalence rates for these diagnoses exceed recorded rates for other American Native and non-Native groups. For each category of violent death, suicide, homicide, accidents and alcohol, rates for Alaska Natives are higher than rates for Alaska non-Natives, American Indians and the U.S. (all races) and are rising. The data suggest a public health problem in which the primary elements are behavioral disturbance and violent death.

Adolescent↗
PubMed1990

Limited efficacy of a Haemophilus influenzae type b conjugate vaccine in Alaska Native infants. The Alaska H. influenzae Vaccine Study Group.

BACKGROUND: The prevention of invasive Haemophilus influenzae type b disease requires a vaccine that is effective when administered during the first six months of life. The infants of Alaska Natives are at particularly high risk of invasive H. influenzae type b disease. METHODS: To evaluate the protective efficacy of a H. influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (polyribosylribitol phosphate-diphtheria toxoid [PRP-D]), we enrolled 2102 Alaska Native infants in a randomized, double-blind, placebo-controlled trial in which either the vaccine or a saline placebo was administered at approximately two, four, and six months of age. RESULTS: After 3969 subject-years of follow-up and 32 episodes of H. influenzae type b disease, the overall incidence of invasive disease was not reduced significantly in the vaccinated subjects (6.0 cases per 1000 patient-years), as compared with the placebo controls (9.6) or with other Alaska Native infants (6.0). After one, two, or three doses there was no significant protective efficacy with the vaccine; after three doses the efficacy was only 35 percent (95 percent confidence interval, -57 to 73). The lack of efficacy was not related to the age at onset of disease, age at immunization, type of disease, degree of Alaska Native heritage, time after immunization, or year of the study. Levels of H. influenzae type b anticapsular antibody in recipients of the vaccine became significantly higher than levels in those who received placebo only after the second and third doses. Even after the third dose, only 48 percent of the vaccinated infants had antibody levels of more than 0.1 microgram per milliliter (geometric mean titer, 0.18). Antibody responses did not vary with the level of maternally acquired antibody, degree of Alaska Native ancestry, or age at time of the first or second immunizations, but they increased with increasing age at time of the third dose (P less than 0.001). CONCLUSIONS: We found no evidence that the PRP-D vaccine provides significant protection, at least for Alaska Native infants, against invasive diseases caused by H. influenzae type b. The ineffectiveness of the vaccine paralleled its limited immunogenicity.

Age Factors↗
PubMed1989

A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: description and evaluation.

Presented here are a detailed description and outcome evaluation of a comprehensive, macro-level Fetal Alcohol Syndrome prevention program for Native Americans and Alaska Natives. The program was designed to provide native communities throughout the United States with the knowledge, skills and strategies to initiate primary, secondary and tertiary prevention measures on their own. The key to the program was the training of a cadre of trainers/advocates in all local Native American and Alaska Native communities served by the Indian Health Service. These people were then supported and assisted in their efforts through a variety of means. Evaluation results of knowledge gained indicate that the local trainers had substantial success in imparting FAS information to a variety of audiences (prenatal groups, school children and community groups). Further, the evaluation samples also indicate that the knowledge was retained by the groups over time (2-4 months) and that there may have been some general diffusion of knowledge among peers in local communities. This program is presented in the hope that it will be replicated and improved upon by similar programs using this model as a base.

Adult↗
PubMed1991

Clustering of hepatocellular carcinoma in Alaska Native families.

Alaska Natives have a high incidence of hepatocellular carcinoma (HCC), with regional, ethnic, village, and familial clustering. During 1969-1988, 15 of the 45 incident cases of HCC in Alaska Natives occurred in 5 families. This report presents epidemiologic, virologic, and immunogenetic data on these 5 families. The results of hepatitis B virus (HBV) serologic testing indicates that HBV infection was an important factor in 4 of the 5 families. Human lymphocyte antigen (HLA) testing was performed in 3 families. The HLA results are reviewed in relationship to the familial clustering of HCC.

Adolescent↗
PubMed1991

Suicide in Alaska Natives, 1979-1984.

Alaska native suicide data were reviewed for every Alaska native suicide (N = 90) from death certificate data for the years 1979-1984 and compared to suicide statistics of age- and sex-matched groups of the entire U.S. population. The yearly suicide rate for Alaska natives was about twice that for the United States. Most of this difference was accounted for by dramatically and significantly greater rates for young, single, Alaska native men compared to white men in the U.S.; this was true for both the 15-24 and 25-34 age groups. With advancing age, suicide rates among Alaska natives decreased; the rates for the 35-44 and 45-54 male groups were still much greater, but not significantly so, than the rates for the comparable U.S. groups. After age 55, no suicides were reported for Alaska natives while U.S. white men had their highest suicide rates in the 55-64 and 65 and above groups. A number of social factors appear to have fueled the rise in suicide rates in young Alaska native men, including: economic growth, industrialization and changing lifestyles; prevalence of firearms; and a high rate of alcoholism.

Adolescent↗
PubMed1988

Haemophilus influenzae type b anticapsular antibody responses to PRP-pertussis and PRP-D vaccines in Alaska native infants.

To evaluate immune responses in Alaska Native infants at high risk for invasive Haemophilus influenzae type b (Hib) disease, we studied PRP-pertussis and PRP-D conjugate vaccines in this population relative to responses in white infants in California and New York. Infants were immunized at two, four, and six months of age (both vaccines). In the PRP-pertussis trial, there were no significant differences in antibody levels at any age between Alaska Native infants and infants from California. Only 50% of the infants had a twofold or greater antibody rise after three doses. In the PRP-D trial, antibody levels at two months of age (presumably maternally acquired) were significantly higher for Alaska Native infants compared with infants from New York (P = .002). There were no significant differences in antibody levels after any of the three doses. Among Alaska Native infants there was no significant difference in antibody response based upon degree of ethnic purity.

Alaska↗
PubMed1990

Federal nutrition services for American Indian and Alaska native elders.

American Indian and Alaska native elders have a poverty rate of 61% and a life expectancy between 3 and 4 years less than that of the general older U.S. population. In 1978, Congress enacted a separate title under the Older Americans Act to address some of the special needs of American Indian elders. Since enactment of specific provisions for American Indians, Congress has continued to amend the Older Americans Act to ensure that the nutritional needs of American Indian elders are addressed. Currently, federal nutrition services are provided to American Indian and Alaska native elders through both Title III, Grants for State and Community Programs on Aging, Part C, Nutrition Services, and Title VI, Grants for Native Americans, of the Older Americans Act. In fiscal year 1987, more than 52,000 American Indian and Alaska elders received meals from congregate nutrition sites and/or home-delivered meals.

Aged↗
PubMed1992

Severity and frequency of sequelae of bacterial meningitis in Alaska Native infants. Correlation with a scoring system for severity of sequelae.

OBJECTIVES: To (1) determine the frequency and severity of sequelae of Haemophilus influenzae type b and Streptococcus pneumoniae meningitis in Alaska Native children, (2) compare morbidity and mortality of H influenzae b and S pneumoniae meningitis, and (3) evaluate the applicability of the Herson-Todd prognostic score (HTPS) to both H influenzae b and S pneumoniae meningitis in this population. DESIGN: A retrospective study of all cases of H influenzae b and S pneumoniae meningitis in Alaska Native children younger than age 5 years. Data on meningitis sequelae, obtained from medical charts and records of the Infant Learning Program, were collected, and incidence of sequelae tabulated. Data obtained on admission to the hospital were used to calculate HTPS. SETTING: Indian Health Service facility for the Yukon-Kuskokwin Delta region of southwest Alaska. STUDY SUBJECTS: 51 of 63 Alaska Native children with H influenzae b meningitis and 13 of the same 63 Alaska Native children with S pneumoniae meningitis occurring between 1980 and 1988. One child was infected with both organisms, producing a total of 64 cases for study. SELECTION PROCEDURES: Cases were identified by surveillance for these diseases between January 1, 1980, and December 31, 1988, maintained by the Arctic Investigations Program, Centers for Disease Control. MEASUREMENTS AND RESULTS: Sequelae of bacterial meningitis caused by H influenzae b were equal to or exceeded rates of sequelae described in other children in the United States. After H influenzae b meningitis, motor abnormalities (29%) and hydrocephalus (7%) occurred two to four times more often in Alaska Native children than in children in other parts of the United States. Differences in severity of H influenzae b sequelae could not be accounted for by microbiologic markers of the H influenzae b strain, including ampicillin sensitivity, biotype, outer membrane protein type, or electropherotype. Numbers of cases of S pneumoniae meningitis were too small for statistically valid comparison, but sequelae of S pneumoniae meningitis occurred in roughly equal proportion as sequelae of H influenzae b meningitis. The HTPS was applied to Alaska Native children with H influenzae b meningitis and was found to be very accurate in predicting children with major sequelae. Analysis of the prognostic factors used in deriving the HTPS revealed a unique set of predictors for sequelae in Alaska Native children: seizures at admission, glucose levels in cerebrospinal fluid of less than 1.1 mmol/L; and male gender, with a significant predictive interaction between male gender and age less than 6 months at admission. CONCLUSIONS: Alaska Native children suffer greater neurologic morbidity as a result of H influenzae b meningitis than do their non-Native counterparts. The HTPS was a good predictor of major sequelae in Alaska Native children with H influenzae b or S pneumoniae meningitis and could be useful in determining which patients need referral to a tertiary care center.

Alaska↗
PubMed1991

Health implications of obesity in American Indians and Alaska Natives.

American Indians and Alaska Natives (AI/ANs) are experiencing an epidemic of diabetes, increasing rates of coronary artery disease and hypertension, and poor survival rates for breast cancer that are likely partially attributable to the increasing prevalence of obesity over the past generation. Obesity may also contribute to the high rates of gallstones and to adverse outcomes of pregnancy in AI/ANs. Although overall mortality was not associated with obesity in Pima Indians (except in the most obese men), the relationship of obesity to longevity in other AI/AN groups is not known. Further study of the specific health effects of obesity in various groups of AI/ANs are needed. In the meantime, community-based programs to prevent obesity and its sequelae should be implemented in all AI/AN communities.

Alaska↗
PubMed1992

The diet of Alaska Native adults: 1987-1988.

Although in the past, rates of heart disease, cancer, and diabetes were lower in Alaska Natives than in US whites, these diseases are now increasing. The rate of iron-deficiency anemia for Alaska Natives continues to be higher than that in the general population. To understand the role of diet in these chronic diseases, seasonal dietary intakes of 351 Alaska Native adults from 11 communities were assessed during 1987-1988. Alaska Natives consumed more energy (19%), protein (39%), fat (21%), carbohydrate (13%), iron (25%), vitamin A (53%), and vitamin C (31%), but less calcium (19%) than did the general US adult population [National Health and Nutrition Examination Survey II (NHANES II)]; Alaska Natives consumed six times more fish but less fruits and vegetables. Results suggest that energy and protein intakes decreased in the last 30 y but the proportion of energy from fat (37%) remained unchanged. High fish consumption and large seasonal dietary variations persisted, which may protect against chronic diseases. However, excess energy and fat and low calcium, fruit, and vegetable intakes may be contributing to recent increases in chronic diseases. Dietary guidelines are proposed.

Adult↗
PubMed1976

Cancer incidence in Alaska natives.

A survey of cancer incidence among Alaska Natives for the 5-year period 1969-73 revealed fewer cancer cases overall than expected in relation to US rates, but significantly increased risk for certain cancer sites: the nasopharynx in both sexes (with excesses over 15-fold), the liver in males, and the salivary glands, gallbladder, kidney and thyroid in females. Compared with earlier reports, the observations suggest marked changes in cancer incidence among Alaska Natives over the past two decades, with declines in esophageal and invasive cervical cancers, and increases in cancers of the lung, colon and rectum.

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↗
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↗
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↗