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Spirituality and attempted suicide among American Indians.

American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15-57yr) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (p(trend) for Christianity=0.22 and p(trend) for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (p(trend)=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality.

Adolescent↗

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↗

The implications of cultural orientation for substance use among American Indians.

American Indians were interviewed about their participation in traditional culture and their substance use behaviors. Analyses indicated that cultural orientation differed by age and employment status. Bicultural or less Indian oriented individuals were more likely to misuse alcohol than their more Indian oriented counterparts. The implications of cultural orientation for substance use behaviors are discussed. The need for more precise conceptualization and measurement of acculturation is recommended.

Adult↗

Histologic comparison of mammary carcinomas among a population of Southwestern American Indian, Spanish American, and Anglo women.

Primary carcinomas of the breast were studied in age-matched populations of Southwestern American Indian, Spanish American, and Anglo women from an area served by the New Mexico Tumor Registry. Histologic tumor type, nuclear grade, and stromal inflammatory response were compared among these three groups. Indian women presented with less favorable tumor stage at diagnosis. Histologic tumor types were similar with the the exception that lobular carcinoma was less frequent among Indian and Spanish American than among Anglo women. Carcinomas from Indian patients showed less differentiated nuclei than those from the other groups.

Adult↗

Inhalant abuse among American Indian, Mexican American, and non-Latino white adolescents.

The abuse of volatile solvents, or inhalants, is an enduring problem among adolescents although a number of factors obscure the nature and extent of this drug using behavior. The data presented here indicate that a number of social and perceptual correlates of inhalant use operate similarly across Mexican American, American Indian and non-Latino white adolescents. Peer factors appear to dominate, although they are somewhat less important for Mexican American and Indian youth. Increased perception of harm reduces inhalant use for all groups. Of particular significance in the findings here are the continued increase of inhalant use among females compared to males and the strong pattern of decreases in inhalant use among American Indian adolescents over the last decade. A number of implications for increased effectiveness of prevention are discussed.

Administration, Inhalation↗

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey.

OBJECTIVES: To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States). DESIGN: A geographically targeted telephone survey. SETTING: Rural New Mexico. PARTICIPANTS: American Indian residents aged 18 years and older. MAIN OUTCOME MEASURES: Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour. RESULTS: Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use. CONCLUSIONS: The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.

Adolescent↗

Anxiety and eating behavior in obese and nonobese American Indians and white Americans.

According to emotional arousal theory (EAT), when emotionally aroused, obese people overeat and nonobese people do not. Lower socioeconomic-status urban obese and nonobese American Indians and White Americans were compared on a test of EAT. Subjects were administered the trait anxiety form of the State-Trait Anxiety Inventory Scale (S-TAIS) and then assigned to a high-anxiety (HA) or low-anxiety (LA) condition. They were then administered the state form of the S-TAIS and given a taste task to determine whether EAT is preditive of eating behaviors for both ethnic groups. Assessment results indicated that women were more trait and state anxious than were men; HA women, all HA subjects, HA American Indians, and nonobese American Indians were more state anxious than were corresponding groups. Behavioral indicator results generally supported EAT: All obese and high-anxiety-condition obese subjects consumed more food than did nonobese and low-anxiety-condition obese subjects, respectively. The overall consumption of food was greater with American Indians than with White Americans. This indicates that EAT does not fully explain American Indian eating behavior. An alternative stress-reaction theory is proposed to more fully account for American Indian eating behavior. Obese and nonobese American Indians overeat in response to stress. When stress occurs more frequently, intensely, and for longer duration, the potential for becoming obese increases (given food availability).

Adult↗

Cancer stage at diagnosis, treatment, and survival among American Indians and non-American Indians in Montana.

BACKGROUND: The intent of the current study was to ascertain whether differences in cancer survival between Montana non-American Indians (non-AI) and Montana American Indians (AI) were related to differences in stage of disease at diagnosis or in the type of treatment received. METHODS: A case-control design was utilized using data from the Montana Central Tumor Registry and the Indian Health Service medical records. AIs diagnosed between January 1, 1984 and December 31, 1993 were the cases in the study, and non-AIs diagnosed in the same period were the controls. Chi-square tests and life table techniques were used to analyze the data. RESULTS: Five hundred twenty-two cases were matched with controls. The 5-year cancer survival rate for AIs was 36% and was 47% among non-AIs. The stage at the time of diagnosis was local in 34% of AIS and 36% of non-AIs. The stage was regional in 30% of AIs and 26% of non-AIs. Distant disease at the time of diagnosis was present in 25% of AIs and 24% of non-AIs, whereas an unknown extent of disease was present in 11% of AIs and 14% of non-AIs. AIs underwent surgery less frequently than non-AIs (79% vs. 86%), but this did not appear to contribute to the survival differences observed. CONCLUSIONS: The survival differences observed in the current study cannot be explained easily by differences in the cancer stage at diagnosis or the type of treatment received.

Adult↗

Lifetime prevalence of pathological gambling among american Indian and Hispanic American Veterans.

OBJECTIVES: We examined the prevalence and clinical correlates of pathological gambling among 1228 American Indian and Hispanic American veterans in the southwest and north central regions of the United States. METHODS: We surveyed a community sample of American Indian and Hispanic American veterans to obtain data on psychiatric disorder and treatment. RESULTS: American Indian veterans had a 10% lifetime prevalence of pathological gambling. The Hispanic American lifetime prevalence was less than that of the American Indian veterans but higher than the prevalence found for Hispanic American veterans in other surveys. Comorbid conditions associated with pathological gambling included substance, mood, and antisocial personality disorders. Ready access to casino gambling may encourage, support, or contribute to high rates of pathological gambling in both men and women. CONCLUSIONS: A 70% lifetime comorbidity of psychiatric disorders suggests that early interventions for pathological gambling should consider common psychiatric conditions rather than focusing on pathological gambling alone.

Adolescent↗

Understanding drinking during pregnancy among urban American Indians and African Americans: health messages, risk beliefs, and how we measure consumption.

BACKGROUND: Little is known about urban American Indian and African American women's drinking during pregnancy, or their beliefs about the risk of doing so. However, rates of fetal alcohol syndrome (FAS) are believed to be highest among those ethnic groups. METHODS: The Developing Effective Educational Resources (DEER) project recruited pregnant American Indian, African American, and white women from urban California areas (n = 321), to develop culturally appropriate consumption measures, to gather epidemiological data about drinking during pregnancy, and to assess exposure and reactions to health warnings intended to encourage abstinence during pregnancy. RESULTS: The study found high levels of exposure to health warnings among all ethnic groups, but many women were unclear about the actual consequences of FAS, about the risk of drinking even beer or wine or wine coolers, or about the value of reducing intake at any time during pregnancy. The majority of the women who drank malt liquor, fortified wine, wine, and spirits reported having larger than standard drinks, and daily drinkers had the highest levels of reporting error. When drink size was considered in the calculation of alcohol volume, average daily volume of consumption during pregnancy increased to the FAS risk level (average daily volume > or = 1) in the overall sample and among the African American and white subjects. CONCLUSIONS: Because some women, especially heavy drinkers, will continue drinking despite exposure to abstention-oriented health messages, it may be prudent to develop campaigns and interventions that provide factual information to help at-risk women reduce their drinking during pregnancy. Women could be advised of beverage equivalency, of standard drink sizes, and of how their own drinks compare with standard ones. Reliance on standard drink sizes in research can result in significant underreporting of consumption, especially among pregnant risk drinkers.

Black or African American↗

Maxillary first premolar angular differences between North American Indians and non-North American Indians.

A quantitative technique for obtaining angular data on human maxillary first premolar teeth is presented. Measurement indicates that North American Indian buccal cusps are either buccolingually compressed mesially, or expanded distally, or both, when compared with non-Indian teeth. Surprisingly, data on Chinese and Eskimo samples are similar to non-Indian teeth rather than Indian teeth. Similar techniques may be applied to the more complex multicusped molar teeth in order to extract quantitative data from them.

Asian People↗

A diabetes prevention assessment tool for American Indians.

INTRODUCTION: American Indians have a disproportionately higher risk of developing type 2 diabetes. Few data are available about the perceptions of diabetes among American Indians, and no culturally appropriate tools are available for assessment of perceptions related to health and diabetes. METHODS: A diabetes prevention assessment tool was developed to measure perceptions of health and diabetes among American Indians. Predominant themes from qualitative interviews were used to develop the items for the tool. Data were collected at two autumn powwows, or intertribal dances, in Oklahoma. Reliability testing was performed using 185 surveys from American Indian adults not living on reservations. Principal axis factor analysis was performed to identify possible relationships among the items. RESULTS: Five themes, or factors, were found to categorize the perceptions of health: 1) lifestyles, 2) barriers to healthy lifestyles, 3) personal responsibility, 4) self-care behaviors, and 5) culturally defined well-being. Two factors classified the perceptions of diabetes: 1) a cognitive factor, related to personal experience, and 2) an affective factor, related to emotions. CONCLUSION: Our diabetes assessment tool identified factors that should be considered when developing health promotion and diabetes prevention programs for American Indians. A valid assessment tool for the American Indian population could provide valuable, formative data that would increase understanding of the culturally related obstacles to health promotion and diabetes prevention.

Adolescent↗

Defining disparities in cardiovascular disease for American Indians: trends in heart disease and stroke mortality among American Indians and whites in Montana, 1991 to 2000.

BACKGROUND: Disparities in stroke and heart disease have been well defined in many populations in the United States. Relatively few studies, however, have assessed current disparities in cardiovascular disease in American Indian populations and compared trends with other regions of the United States. METHODS AND RESULTS: Using mortality data, age-adjusted all-cause, heart disease, and stroke mortality rates (per 100,000) were calculated for American Indians and whites from 1991 to 1995 and 1996 to 2000. The all-cause mortality rate was strikingly higher for American Indians than for whites. For example, during 1996 to 2000, the all-cause mortality rate for American Indians (1317, +/-61) was more than half again greater than that for whites (831, +/-8). Heart disease mortality declined significantly in whites (237 to 216 per 100,000) in Montana over the past decade and declined, although not significantly, in American Indians (326 to 283 per 100,000). Stroke mortality also declined significantly in whites (64 to 60 per 100,000) but not in American Indians (80 to 81 per 100,000) during this time period. The proportion of deaths before age 65 years for heart disease and stroke was considerably higher in Indian men (45% and 36%) and Indian women (29% and 28%) compared with white men (21% and 11%) and white women (8% and 7%). CONCLUSIONS: The disparity in heart disease and stroke mortality exists between American Indians and whites in Montana. Regional or state-level surveillance data will be needed to describe the changing patterns of heart disease and stroke mortality and cardiovascular risk factors in many native communities in the United States and Canada.

Alaska↗

At what cost? The social impact of American Indian gaming.

American Indian gaming has been called the "new buffalo." It has the potential to greatly influence cultural traditions on American Indian reservations. This study looks at the social impact that American Indian gaming is having on one reservation in northern Minnesota. Tribal members share strong feelings, both positive and negative, about the issue. Concerns about gaming include an increase in gambling abuse and addiction; a lack of appropriate child care; and concern that gaming is replacing traditional social activities. Some express concern that American Indian values are being replaced by materialism. Supporters of gaming point out that gaming provides tribal members with an opportunity to learn job skills and have gainful employment. Implications for social policy are given.

Cultural Characteristics↗

Factors influencing the pursuit of educational opportunities in American Indian students.

American Indians are the most under-represented minority group across all levels of education. The present study investigates sociocultural, psychological, and nontraditional academic factors that influence American Indian students' decisions to pursue higher education (e.g., vocational training, college). Nineteen American Indians with previous academic difficulties completed several self-report measures at the beginning of an eight-week Job Corps. program. The results indicate that students who pursue educational opportunities have a more realistic self-appraisal of their academic abilities and are supported by others (e.g., family, mentors) in their academic pursuits. A hypothesized link between self-appraisal and support suggests that the availability of a mentor and/or family support is crucial in American Indian students' decision to pursue educational opportunities.

Adolescent↗

Dietary micronutrients and cervical dysplasia in southwestern American Indian women.

American Indian women in the Southwest have high rates of cervical cancer and cervical dysplasia in contrast to low rates of cancers for other sites. Despite their high rates of cervical disease, no published information has specifically examined risk factors for cervical cancer or cervical dysplasia among American Indian women. We carried out a pilot case-control study of cervical dysplasia in southwestern American Indian women to examine the relationship of dietary intake of vitamin C, folacin, vitamin E, carotenoids, and retinol with cervical cytological abnormalities. Twenty-four-hour dietary recalls were collected from women with cervical dysplasia (n = 42) and women with normal cervical cytologies (n = 58). Macro- and micronutrient intake was estimated from these recalls utilizing food and nutrient data from the USDA Survey Nutrient Database. Although mean differences between cases and controls were not statistically significant for any of the micronutrients examined, women with low intake of vitamin C, folacin, and vitamin E were at increased risk of having cervical dysplasia when the data were analyzed as stratified for level of intake (low vs. high intake odds ratios were 3.0 for vitamin C, 3.3 for folacin, and 1.7 for vitamin E). The relationship between dietary micronutrients and cervical dysplasia among American Indian women warrants further investigation using more refined measures of dietary micronutrient intake, together with consideration of other risk factors for cervical disease.

Adult↗

American Indian working women: correlates of subclinical depression among American Indian women.

The purpose of this study was to examine the extent to which role conflict, life satisfaction, self-esteem, instrumentality, expressiveness, age and education predicts ambulatory depression among a community based sample of urban American Indian working women. The convenience sample consisted of a total of 148 Midwestern American Indian working women, ranging in age from 18 to 65 years. Participants completed five instruments assessing gender-related traits of instrumentality and expressiveness, self-esteem, depression, life satisfaction, role conflict, and socio-demographic information. A forced entry stepwise multiple regression was conducted which included all the designated predictor variables. The significant negative Beta in Step 1 indicated that women scoring on the Masculinity (instrumentality) sub-scale were less likely to have a high depression score. The prediction of depression by the Masculinity sub-scale was no longer significant after the life satisfaction and self-esteem variables were added to the equation in Step 2. There was a significant inverse relationship for life satisfaction and self-esteem in predicting the criterion variable, depression. Thirty-two percent of the variance in the prediction of the dependent variable (depression scores) was accounted for by the six variables. In counselling urban American Indian women, supporting instrumentality, enhancing self-esteem and life satisfaction, can positively impact on ambulatory dysphoria.

Adolescent↗