Place of Origin and Violent Disagreement Among Asian American Families: Analysis Across Five States

We examined the prevalence of and factors associated with violent and heated disagreements in the Asian American families, with an emphasis on place of birth differences between parent and child. Data were obtained from the 2003 National Survey of Children’s Health, limited to five states with the highest concentration of Asian-Americans (n = 793). Multivariable analysis used generalized logistic regression models with a three-level outcome, violent and heated disagreement versus calm discussion. Violent disagreements were reported in 13.7% of Asian-American homes and 9.9% of white homes. Differential parent–child place of birth was associated with increased odds for heated disagreement in Asian-American families. Parenting stress increased the likelihood of violent disagreements in both Asian-American and white families. Asian-American families are not immune to potential family violence. Reducing parenting stress and intervening in culturally appropriate ways to reduce generation differences should be violence prevention priorities.     

Peer Reviewed: Risks to Health Among American Indian/Alaska Native High School Students in the United States

Introduction

According to the World Health Organization, the 10 leading risk factor causes of death in high-income countries are tobacco use, high blood pressure, overweight and obesity, physical inactivity, high blood glucose, high cholesterol, low fruit and vegetable intake, urban air pollution, alcohol use, and occupational risks. We examined the prevalence of some of the leading risks to health among nationally representative samples of American Indian/Alaska Native (AI/AN) high school students and compared rates across racial/ethnic groups.

Methods

We combined data from the 2001, 2003, 2005, 2007, and 2009 national Youth Risk Behavior Survey. The survey is a biennial, self-administered, school-based survey of 9th- through 12th-grade students in the United States. Overall response rates for the surveys ranged from 63% to 72%. Of 73,183 participants, 952 were AI/AN students.

Results

For 7 of the 16 variables examined in this study, the prevalence among AI/AN high school students was higher than the prevalence among white high school students. For 1 variable (ate fruit and vegetables <5 times per day), the prevalence among AI/AN students was significantly lower than that among white students. The prevalence for the remaining 8 variables was similar among AI/AN students and white students. These findings also show differences in the prevalence of some behaviors among AI/AN, black, and Hispanic students.

Conclusion

These findings show the prevalence of some health risk behaviors was significantly higher among AI/AN high school students than among high school students in other racial/ethnic groups.     

Cultural Identity Among Urban American Indian/Alaska Native Youth: Implications for Alcohol and Drug Use

American Indian / Alaska Native (AI/AN) youth exhibit high rates of alcohol and other drug (AOD) use, which is often linked to the social and cultural upheaval experienced by AI/ANs during the colonization of North America. Urban AI/AN youth may face unique challenges, including increased acculturative stress due to lower concentrations of AI/AN populations in urban areas. Few existing studies have explored cultural identity among urban AI/AN youth and its association with AOD use. This study used systematic qualitative methods with AI/AN communities in two urban areas within California to shed light on how urban AI/AN youth construct cultural identity and how this relates to AOD use and risk behaviors. We conducted 10 focus groups with a total of 70 youth, parents, providers, and Community Advisory Board members and used team-based structured thematic analysis in the Dedoose software platform. We identified 12 themes: intergenerational stressors, cultural disconnection, AI/AN identity as protective, pan-tribal identity, mixed racial-ethnic identity, rural vs. urban environments, the importance of AI/AN institutions, stereotypes and harassment, cultural pride, developmental trajectories, risks of being AI/AN, and mainstream culture clash. Overall, youth voiced curiosity about their AI/AN roots and expressed interest in deepening their involvement in cultural activities. Adults described the myriad ways in which involvement in cultural activities provides therapeutic benefits for AI/AN youth. Interventions that provide urban AI/AN youth with an opportunity to engage in cultural activities and connect with positive and healthy constructs in AI/AN culture may provide added impact to existing interventions.     

Peer Reviewed: Chronic Disease Risk Factors Among American Indian/Alaska Native Women of Reproductive Age

Introduction

The magnitude of chronic conditions and risk factors among American Indian/Alaska Native women of reproductive age is unknown. The objective of our study was to estimate this magnitude.

Methods

We analyzed data for 2,821 American Indian/Alaska Native women and 105,664 non-Hispanic white women aged 18 to 44 years from the 2005 and 2007 Behavioral Risk Factor Surveillance System. We examined prevalence of high cholesterol, high blood pressure, diabetes, body mass index (kg/m²) ≥25.0, physical inactivity, smoking, excessive alcohol consumption, and frequent mental distress, and the cumulative number of these chronic conditions and risk factors (≥3, 2, 1, or 0). In a multivariable, multinomial logistic regression model, we examined whether American Indian/Alaska Native race was associated with the cumulative number of chronic conditions and risk factors.

Results

American Indian/Alaska Native women, compared with white women, had significantly higher rates of high blood pressure, diabetes, obesity, smoking, and frequent mental distress. Of American Indian/Alaska Native women, 41% had 3 or more chronic conditions or risk factors compared with 27% of white women (χ² , P < .001). After adjustment for income, education, and other demographic variables, American Indian/Alaska Native race was not associated with having either 1, 2, or 3 or more chronic conditions or risk factors.

Conclusion

Three out of every 5 American Indian/Alaska Native women aged 18 to 44 years have 3 or more chronic conditions or risk factors. Improving economic status and education for AI/AN women could help eliminate disparities in health status.     

Self-reported asthma among American Indian and Alaska Native people in Alaska

This study describes the lifetime prevalence of self-reported asthma among American Indian and Alaska Native (AI/AN) people who participated in the Education and Research Towards Health (EARTH) study in Alaska. We conducted a cross-sectional analysis of asthma prevalence by sex and its associations with sociodemographic, health, and environmental factors. Among 3,828 AI/AN adults, we found a higher age-sex adjusted prevalence of asthma (15.4%) than is found in the general U.S. adult (11.0%) population based on the 2006 National Health Interview Survey. After multivariable analysis, self-reported asthma among men was associated with increased age, unemployment, lower income, and obesity. Among women, self-reported asthma was associated with increased age, being divorced/separated, living in Alaska's southcentral region, self-reported fair/poor health status, obesity, and indoor mold. Our data suggest that AI/AN adults have higher prevalence of lifetime asthma than the general U.S. population. Further study is necessary to understand asthma in this population.     

Peer Reviewed: Chronic Disease Risk Factors Among Alaska Native and American Indian People,Alaska, 2004-2006

Introduction

The Alaska Education and Research Towards Health (EARTH) Study is being conducted to determine the prevalence of clinically measured chronic disease risk factors in a large population of American Indian/Alaska Native people (AI/AN). We report these estimates and compare them with those for the overall US population, as assessed by the National Health and Nutrition Examination Survey (NHANES).

Methods

We measured blood pressure, height, weight, and fasting serum lipids and glucose in a prospective cohort of 3,822 AI/AN participants who resided in Alaska during 2004 through 2006. We categorized participants as having chronic disease risk factors if their measurements exceeded cutoffs that were determined on the basis of national recommendations. We analyzed the prevalence of risk factors by sex and age and compared the age-adjusted prevalence with 1999-2004 NHANES measurements.

Results

EARTH participants were significantly more likely than NHANES participants to be overweight or obese and to have impaired fasting glucose, low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, and hypertension. The prevalence of high total cholesterol and triglycerides was not significantly different between the 2 study populations.

Conclusion

We provide baseline clinical measurements for chronic disease risk factors for a larger study sample than any previous study of AI/AN living in Alaska. The prevalence of most risk factors measured exceeded national rates. These data can be used to tailor health interventions and reduce health disparities.     

Barriers to Cancer Clinical Trial Participation Among American Indian and Alaska Native Tribal College Students

Purpose: American Indians and Alaska Natives (AIs/ANs) have some of the highest cancer‐related mortality rates of all US racial and ethnic groups, but they are underrepresented in clinical trials. We sought to identify factors that influence willingness to participate in cancer clinical trials among AI/AN tribal college students, and to compare attitudes toward clinical trial participation among these students with attitudes among older AI/AN adults. Methods: Questionnaire data from 489 AI/AN tribal college students were collected and analyzed along with previously collected data from 112 older AI/AN adults. We examined 10 factors that influenced participation in the tribal college sample, and using chi‐square analysis and these 10 factors, we compared attitudes toward research participation among 3 groups defined by age: students younger than 40, students 40 and older, and nonstudent adults 40 and older. Findings: About 80% of students were willing to participate if the study would lead to new treatments or help others with cancer in their community, the study doctor had experience treating AI/AN patients, and they received payment. Older nonstudent adults were less likely to participate on the basis of the doctor's expertise than were students (73% vs 84%, P = .007), or if the study was conducted 50 miles away (24% vs 41%, P= .001). Conclusions: Finding high rates of willingness to participate is an important first step in increasing participation of AIs/ANs in clinical trials. More information is needed on whether these attitudes influence actual behavior when opportunities to participate become available.     

American Indian/Alaska Native Uninsurance Disparities: A Comparison of 3 Surveys

Objectives. We examined whether 3 nationally representative data sources produce consistent estimates of disparities and rates of uninsurance among the American Indian/Alaska Native (AIAN) population and to demonstrate how choice of data source impacts study conclusions.Methods. We estimated all-year and point-in-time uninsurance rates for AIANs and non-Hispanic Whites younger than 65 years using 3 surveys: Current Population Survey (CPS), National Health Interview Survey (NHIS), and Medical Expenditure Panel Survey (MEPS).Results. Sociodemographic differences across surveys suggest that national samples produce differing estimates of the AIAN population. AIAN all-year uninsurance rates varied across surveys (3%–23% for children and 18%–35% for adults). Measures of disparity also differed by survey. For all-year uninsurance, the unadjusted rate for AIAN children was 2.9 times higher than the rate for White children with the CPS, but there were no significant disparities with the NHIS or MEPS. Compared with White adults, AIAN adults had unadjusted rate ratios of 2.5 with the CPS and 2.2 with the NHIS or MEPS.Conclusions. Different data sources produce substantially different estimates for the same population. Consequently, conclusions about health care disparities may be influenced by the data source used.Access to quality health care is a priority for the nation. Access to such care is designated in Healthy People 2010 as one of the 10 Leading Health Indicators, marking it as a priority area for improving the health of the nation¹ and reducing health disparities.² American Indians/Alaska Natives (AIANs) are one group that continues to have substantial health disparities compared with other racial groups.^3–8 However, disparities in health care coverage and access for AIANs have received only intermittent attention,^9–13 leaving a marked gap in our understanding. Previously documented issues for research on AIAN health care disparities include gaps in data availability for AIANs^14,15 as well as problems with national-level estimates masking the differences across geographic areas.^13,16 However, it is also possible that there are differences in the magnitude of estimates or the conclusions drawn, depending on which data source is used to examine health care disparities.Because no single data source contains all possible measures of health and health care, different data sources are often used to answer complementary but different questions. In the case of national surveillance and annual snapshot reports, information from numerous data sources are used to present a more complete picture of health for the US population. Healthy People 2010 uses National Health Interview Survey (NHIS) data to monitor insurance coverage and access to a usual source of care and uses National Vital Statistics System data to monitor access to prenatal care.¹ In the chapter on access to care, the National Healthcare Disparities Report also uses NHIS data to examine uninsurance and access to a usual source of care but uses the Medical Expenditure Panel Survey (MEPS) to examine all-year uninsurance and access to a primary care provider.¹⁷ A few recent studies that examined health care access for AIANs used other data sources, such as the National Survey of America''s Families¹² or the Behavioral Risk Factor Surveillance Survey.¹³We use 3 general population surveys commonly used for health care coverage and access research to examine the implications of using different data sources for estimating health care disparities specific to AIANs. We use uninsurance disparities as an example but acknowledge at the outset that different data sources measure insurance coverage in different ways. Our purpose is not to critically review measures of uninsurance or to critique the surveys that collect these data. Rather, we aim to demonstrate that choice of data source matters for disparities research, often for a variety of reasons. Our intent is 2-fold: (1) to examine whether 3 nationally representative data sources produce trustworthy and consistent estimates of the AIAN population in the United States and (2) to highlight the impact that choice of data source can have on conclusions about uninsurance disparities.     

Occupational and environmental exposures among Alaska Native and American Indian people living in Alaska and the Southwest United States

Most occupational and environmental research describes associations between specific occupational and environmental hazards and health outcomes, with little information available on population-level exposure, especially among unique subpopulations. The authors describe the prevalence of self-reported lifetime exposure to nine occupational and environmental hazards among 11,326 American Indian and Alaska Native (AI/AN) adults enrolled in the Education and Research Towards Health (EARTH) Study in the Southwest U.S. and Alaska. The top three hazards experienced by AI/AN people in Alaska were petroleum products, military chemicals, and asbestos. The top three hazards experienced by AI/AN living in the Southwest U.S. were pesticides, petroleum, and welding/silversmithing. The study described here found that male sex, lower educational attainment, AI/AN language use, and living in the Southwest U.S. (vs. Alaska) were all associated with an increased likelihood of hazard exposure. The authors' study provides baseline data to facilitate future exposure-response analyses. Future studies should measure dose and duration as well as environmental hazards that occur in community settings.     

Disparities in infectious disease hospitalizations for American Indian/ Alaska Native people

Objectives

We described disparities in infectious disease (ID) hospitalizations for American Indian/Alaska Native (AI/AN) people.

Methods

We analyzed hospitalizations with an ID listed as the first discharge diagnosis in 1998–2006 for AI/AN people from the Indian Health Service National Patient Information Reporting System and compared them with records for the general U.S. population from the Nationwide Inpatient Survey.

Results

The ID hospitalization rate for AI/AN people declined during the study period. The 2004–2006 mean annual age-adjusted ID hospitalization rate for AI/AN people (1,708 per 100,000 populiation) was slightly higher than that for the U.S. population (1,610 per 100,000 population). The rate for AI/AN people was highest in the Southwest (2,314 per 100,000 population), Alaska (2,063 per 100,000 population), and Northern Plains West (1,957 per 100,000 population) regions, and among infants (9,315 per 100,000 population). ID hospitalizations accounted for approximately 22% of all AI/AN hospitalizations. Lower-respiratory--tract infections accounted for the largest proportion of ID hospitalizations among AI/AN people (35%) followed by skin and soft tissue infections (19%), and infections of the kidney, urinary tract, and bladder (11%).

Conclusions

Although the ID hospitalization rate for AI/AN people has declined, it remains higher than that for the U.S. general population, and is highest in the Southwest, Northern Plains West, and Alaska regions. Lower-respiratory-tract infections; skin and soft tissue infections; and kidney, urinary tract, and bladder infections contributed most to these health disparities. Future prevention strategies should focus on high-risk regions and age groups, along with illnesses contributing to health disparities.Infectious diseases (IDs) have historically caused widespread morbidity and mortality both worldwide and in the United States.^1–3 IDs remain a public health issue and are of particular concern for the American Indian/Alaska Native (AI/AN) population, which has had excessive ID morbidity and mortality for several decades.^4–9 Both hospitalizations and outpatient visits due to IDs have been disproportionately higher in the AI/AN population compared with the U.S. population.^7,10–13 These disparities affect all ages, especially infants and older adults.^6,8,13 Studies of specific IDs, including lower-respiratory-tract infections (LRTIs), diarrhea-related infections, and skin and ear infections, have also shown a disparity between AI/AN people and the general U.S. population.^{10,11,14–16} However, the trends and disparities of ID hospitalizations for AI/AN people have not been analyzed since an evaluation of 1994 ID hospitalizations.⁷We determined the epidemiology and trends of ID hospitalizations for AI/AN people in 1998–2006 using Indian Health Service (IHS) inpatient data to assess any changes in their ID burden, and to determine high-risk regions and age groups that should be targeted for further intervention. We also compared the trends and rates for AI/AN people with those for the general U.S. population to determine whether health disparities in ID hospitalizations remain for AI/AN people.