Prenatal Cigarette Smoking and Smokeless Tobacco Use Among Alaska Native and White Women in Alaska, 1996–2003

Objective To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. Methods Using 1996–2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. Results Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. Conclusion The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Patterns of Cigarette and Smokeless Tobacco Use Before, During, and After Pregnancy Among Alaska Native and White Women in Alaska, 2000–2003

Objective To examine patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska Native (AN) and white women living in Alaska. Methods We used data from the 2000–2003 population-based Pregnancy Risk Assessment Monitoring System to describe patterns of self-reported prenatal tobacco use among AN and white women. We used multiple variable logistic regression analysis to identify maternal factors associated with quitting and relapse. The final sample included 5,458 women. Results During 2000–2003, the prevalence of any tobacco use before pregnancy was twofold higher among AN women than among white women (60.0 vs. 27.5%), and the prevalence of any tobacco use during pregnancy and after pregnancy were each nearly threefold higher. Of the 25.8% (SE 0.9) of white women who smoked before pregnancy, 49.0% (SE 2.1) reported that they quit during pregnancy and of those, 41.1% (SE 2.9) relapsed postpartum. Of the 38.5% (SE 0.9) of AN women who smoked before pregnancy, 35.7% (SE 1.4) quit, and of those 57.0% (SE 2.4) relapsed. Of the 14.2% of AN women who chewed tobacco before pregnancy, 15.7% (SE 1.7) quit, and of those, 52.9% (SE 5.9) relapsed. Conclusion During 2000–2003, the prevalence of tobacco use was two to three times higher among AN women than among white women before, during, and after pregnancy. In addition, AN women had lower quit rates and higher relapse rates than white women. Comprehensive, culturally appropriate tobacco control approaches targeting AN women are needed to increase cessation during pregnancy and to decrease relapse.     

Invasive Early-Onset Neonatal Group B Streptococcal Cases – Alaska, 2000–2004

Objective: We conducted a review of invasive early-onset neonatal group B Streptococcus (GBS) infections that occurred during 2000–2004 in Alaska to determine the proportion of cases that might have been prevented by complete implementation of the 2002 Centers for Disease Control and Prevention (CDC) guidelines. Methods: Cases were identified from statewide laboratory-based surveillance conducted by the CDC Arctic Investigations Program, and from the Alaska Medicaid database using International Classification of Diseases 9 codes 038.0, 041.02, 320.2, and 482.3. Neonates were considered to have early-onset disease if clinical illness within 6 days after birth was accompanied by GBS isolation from a normally sterile site. Maternal and neonatal medical records were reviewed. Potentially preventable cases were those for whom the 2002 CDC GBS maternal screening and intrapartum antimicrobial prophylaxis (IAP) guidelines were not completely implemented. Preventability of events not related to clinician implementation of the guidelines were not considered. Results: Twenty-one neonates with invasive early-onset GBS disease were identified (0.42/1,000 live births). Three of the eight mothers for whom IAP was indicated, did not receive adequate IAP. Nine of the 13 mothers for whom there was no indication for IAP, had not been screened appropriately. Therefore, a total of 12 neonates were determined to have had potentially preventable GBS disease. Conclusions: Over 50% of the invasive early-onset neonatal GBS cases in Alaska were potentially preventable. The majority of these cases may have been prevented by closer adherence to either specific IAP administration guidelines or to maternal screening guidelines. Financial support or conflicts of interest: Dr. Gessner has received funding support from sanofi-pasteur, a vaccine manufacturer, and research support from TAP Pharmaceuticals. None of the other authors have financial support to declare. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

The Decrease in the Unintentional Injury Mortality Disparity Between American Indians/Alaska Natives and Non–American Indians/Alaska Natives in New Mexico, 1980 to 2009

Objectives. We tracked the unintentional injury death disparity between American Indians/Alaska Natives and non–American Indians/Alaska Natives in New Mexico, 1980 to 2009.Methods. We calculated age-adjusted rates and rate ratios for unintentional injury deaths and their external causes among American Indians/Alaska Natives and non–American Indians/Alaska Natives. We tested trend significance with the Mann–Kendall test.Results. The unintentional injury death rate ratio of American Indians/Alaska Natives to non–American Indians/Alaska Natives declined from 2.9 in 1980–1982 to 1.5 in 2007–2009. The rate among American Indians/Alaska Natives decreased 47.2% from 1980–1982 to 1995–1997. Among non–American Indians/Alaska Natives, the rate declined 25.3% from 1980–1982 to 1992–1994, then increased 31.9% from 1992–1994 to 2007–2009. The motor vehicle traffic and pedestrian death rates decreased 57.8% and 74.6%, respectively, among American Indians/Alaska Natives from 1980–1982 to 2007–2009.Conclusions. The unintentional injury death rate disparity decreased substantially from 1980–1982 to 2007–2009 largely because of the decrease in motor vehicle crash and pedestrian death rates among American Indians/Alaska Natives and the increase in the poisoning death rate among non–American Indians/Alaska Natives.New Mexico had the highest unintentional injury death rate in the nation for the years 2006 through 2008.1 The unintentional injury death rate in the state, 67.1 deaths per 100 000 population, was 1.7 times higher than the US unintentional injury death rate, 39.7 per 100 000 population. In New Mexico, unintentional injuries are the third leading cause of death for all ages and are the leading cause of death for persons aged 1 to 44 years. From 2007 through 2009, poisoning was the leading cause of unintentional injury death. Motor vehicle crashes and falls were the second and third leading causes of unintentional injury death, respectively. These 3 leading causes of unintentional injury death accounted for 85% of all unintentional injury deaths in the state.Nationally, the unintentional injury death rate among the American Indian/Alaska Native (AI/AN) population in the Indian Health Service Area from 2004 to 2006 was 2.4 times higher than the rate for all races in the United States in 2005.2 Whereas American Indians/Alaska Natives in New Mexico have lower rates of death from heart disease, cancer, chronic obstructive pulmonary disease, and stroke than non–American Indian/Alaska Natives, their unintentional injury death rate is higher than the rate among non–American Indians/Alaska Natives.3 Among New Mexico residents, American Indians had the highest total injury mortality rate from 1958 to 1982.4 However, the trend in the disparity in the unintentional injury death rate between American Indians/Alaska Natives and non–American Indians/Alaska Natives in New Mexico has not been examined.The 2007–2009 AI/AN population in New Mexico averaged 201 952, which represented 10.2% of the state’s population.5 The non–AI/AN population averaged 1 786 436, which represented 89.8% of the state’s population.5 By comparison, American Indians/Alaska Natives comprised 1.1% of the US population for 2007 through 2009.5The purpose of this study was to track the disparity in unintentional injury death and external causes of unintentional injury death between the AI/AN population and the non-AI/AN population in New Mexico from 1980 to 2009.     

Are very low birthweight births among American Indians and Alaska Natives underregistered?

BACKGROUND: International infant mortality rates vary widely. This variation has been attributed to many factors, including differential reporting. In the US, American Indians and Alaska Natives (AI/AN), who generally have low socioeconomic status, have a low neonatal mortality rate. One possible explanation is underregistration of very low birthweight (VLBW, < 1,500 g) births. We hypothesized that underregistration may occur disproportionately among AI/AN residing on or near reservations (areas controlled by an American Indian group). We estimated infant mortality in these areas. METHODS: Linked birth-infant death files for 1989-1991 were used to compare VLBW and neonatal mortality among AI/AN infants in counties with reservations with those in non-reservation counties. The VLBW rates for non-reservation counties were applied to the reservation risk distribution to calculate directly adjusted VLBW and neonatal mortality rates for reservation counties. This method assumes that greater registration in non-reservation counties yields a more accurate estimate of the relationship between risk factors and outcomes. RESULTS: Despite a higher prevalence in reservation counties of risk factors, the reported VLBW rate was 0.84% in reservation and 1.17% in non-reservation counties. The neonatal mortality rate was 5.4 per 1,000 in reservation counties and 6.0 in non-reservation counties. Direct adjustment yielded a VLBW rate of 1.28% (95% CI: 1.14-1.39) and a neonatal mortality rate of 6.7-9.8 per 1,000 in reservation counties. CONCLUSIONS: Reported neonatal mortality among AI/AN may understate the true rate due to underregistration of VLBW births. Direct adjustment may be useful in estimating infant mortality rates for populations with incomplete vital registration.     

Haemophilus influenzae Serotype a Invasive Disease,Alaska, USA, 1983–2011

Before introduction of Haemophilus influenzae type b (Hib) vaccines, rates of Hib disease in Alaska’s indigenous people were among the highest in the world. Vaccination reduced rates dramatically; however, invasive H. influenzae type a (Hia) disease has emerged. Cases of invasive disease were identified through Alaska statewide surveillance during1983–2011. Of 866 isolates analyzed for serotype, 32 (4%) were Hia. No Hia disease was identified before 2002; 32 cases occurred during 2002–2011 (p<0.001). Median age of case-patients was 0.7 years; 3 infants died. Incidence of Hia infection (2002–2011) among children <5 years was 5.4/100,000; 27 cases occurred in Alaska Native children (18/100,000) versus 2 cases in non-Native children (0.5/100,000) (risk ratio = 36, p<0.001). From 12/2009 to 12/2011, 15 cases of Hia disease occurred in southwestern Alaska (in children <5 years, rate = 204/100,000). Since introduction of the Hib conjugate vaccine, Hia infection has become a major invasive bacterial disease in Alaska Native children.     

Increasing non-susceptibility to antibiotics within carried pneumococcal serotypes — Alaska, 2008–2015

BackgroundIn Alaska, while introduction of 13-valent pneumococcal conjugate vaccine led to declines in invasive pneumococcal disease, carriage prevalence remained stable because of replacement with non-vaccine serotypes. We assessed antibiotic non-susceptibility of carried pneumococci during serotype redistribution, determined the contributions of within-serotype shifts, and assessed factors that could explain changes in non-susceptibility.MethodsEach year from 2008 to 2015, at multiple sites in Alaska, we collected nasopharyngeal swabs and completed surveys for a convenience sample of participants. Pneumococcal serotyping and antimicrobial susceptibility testing for penicillin and erythromycin were performed. We described changes in non-susceptibility of isolates from 2008–2011 to 2012–2015, and assessed the contributions of serotype redistribution and within-serotype changes in non-susceptibility by comparing observed data to modeled data removing either factor. We used weighted logistic regression to assess whether reported risk factors could explain changes over time in non-susceptibility within serotypes.ResultsFrom 2008–2011 to 2012–2015, the overall proportion of isolates non-susceptible to penicillin or erythromycin increased by 3%, from 23% (n = 1,183) to 26% (n = 1,589; P < 0.05). However, a decrease of 3% would be expected if serotype redistribution occurred without within-serotype changes in non-susceptibility. Standardization by either factor produced hypothetical data significantly different to observed data. Within serotypes, the average annual increase in odds of non-susceptibility to penicillin or erythromycin was 1.08 (95% CI 1.05–1.11). Recent antibiotic exposure, urban residence and increased household size of participants predicted isolate non-susceptibility but did not explain the increase over time.DiscussionAn overall increase in non-susceptibility of carried pneumococcal isolates to penicillin or erythromycin resulted from increases in non-susceptibility within serotypes, which outweighed a protective effect of serotype redistribution. Characterization of emerging resistant clones within carried non-vaccine serotypes, including risk factors for colonization and disease, would support disease prevention efforts and inform vaccine strategies.     

Urban American Indian and Alaska Native Youth: Youth Risk Behavior Survey 1997–2003

Objective To examine the prevalence of health risk-behaviors among American Indian/Alaska Native (AI/AN) youth in urban areas. Methods Data from the national Youth Risk Behavior Survey (YRBS) for the years 1997–2003 were used for the analyses (Urban sample = 52,364). The YRBS is a self-report questionnaire administered to a sample of 9th–12th grade students intended to monitor health risk-behaviors. “Urban” is defined as areas within a Metropolitan Statistical Area. Whites are used as the comparison group for the examination of AI/AN estimates. Results Urban AI/AN youth represented 1% of the urban sample (N = 513). The presence of a number of risk-behaviors were at least threefold higher in AI/AN compared to white youth in urban areas, including suicidal behaviors, feeling unsafe at school and needing medical treatment from a fight. Other factors were over twofold higher among AI/AN, including sexual behaviors, illegal drug use, violence at school, and experiences of rape, assault and pregnancy. Conclusions The higher prevalence of health risk-behaviors in urban AI/AN compared to white youth reflects a need for interventions focused on urban AI/AN youth.     

Elevated Blood Lead Levels Among Fire Assay Workers and Their Children in Alaska, 2010–2011

In October 2010, an employee at Facility A in Alaska that performs fire assay analysis, an industrial technique that uses lead-containing flux to obtain metals from pulverized rocks, was reported to the Alaska Section of Epidemiology (SOE) with an elevated blood lead level (BLL) ≥10 micrograms per deciliter (μg/dL). The SOE initiated an investigation; investigators interviewed employees, offered blood lead screening to employees and their families, and observed a visit to the industrial facility by the Alaska Occupational Safety and Health Section (AKOSH). Among the 15 employees with known work responsibilities, 12 had an elevated BLL at least once from October 2010 through February 2011. Of these 12 employees, 10 reported working in the fire assay room. Four children of employees had BLLs ≥5 μg/dL. Employees working in Facility A''s fire assay room were likely exposed to lead at work and could have brought lead home. AKOSH inspectors reported that they could not share their consultative report with SOE investigators because of the confidentiality requirements of a federal regulation, which hampered Alaska SOE investigators from fully characterizing the lead exposure standards.Occupational lead exposure continues to threaten workers'' health.^1–3 In the United States, the Occupational Safety and Health Administration (OSHA) prescribes standards for permissible exposure limits for lead in the workplace and specifies that a blood lead level (BLL) of 40 micrograms per deciliter (μg/dL) triggers more frequent (i.e., every two months rather than every six months) blood lead testing. OSHA standards require that workers with a BLL ≥60 μg/dL, or an average BLL for the last three tests or all tests during the previous six months (whichever is longer) of ≥50 μg/dL, be removed from the lead exposure area, unless the most recent test indicated a BLL ≤40 μg/dL.⁴ However, research has increased concern regarding lead toxicity at lower doses and has supported a reevaluation of the level at which BLLs can be considered safe.⁵ The National Institute for Occupational Safety and Health (NIOSH) defines an elevated BLL in an adult as ≥10 μg/dL.⁶ In addition to adverse impacts on the health of the workers themselves, children of lead-exposed workers have disproportionately higher BLLs when compared with other children.^7–9Elevated BLLs among adults are associated with muscle and joint pain, reproductive problems, and neurologic symptoms, including memory loss.¹⁰ Negative health effects have been observed among adults with only modestly elevated BLLs,^11–13 with increased odds of an ill effect occurring at levels as low as 1.6–2.4 μg/dL.¹¹ Among children, elevated BLLs can result in devastating health effects, including brain and nervous system damage, slow growth, and hearing problems.¹⁰ Research indicates that there is no safe level of lead among children.¹⁴ Despite considerable data on the deleterious health effects of lead regarding both children and adults, harmful occupational exposures that are inadequately controlled continue to put workers and their families at risk. A BLL of ≥5 μg/dL is the reference level that the Advisory Committee on Childhood Lead Poisoning Prevention has recommended to identify children with elevated BLLs.¹⁴ Elevated BLLs ≥10 μg/dL for children and adults are reportable in Alaska under Alaska Administrative Code 27.014.¹⁵     

Vaccine-preventable,hospitalizations among American Indian/Alaska Native children using the 2012 Kid’s Inpatient Database

Our aim was to assess the odds of hospitalization for a vaccine-preventable, infectious disease (VP-ID) in American Indian/Alaska Native (AI/AN) children compared to other racial and ethnic groups using the 2012 Kid’s Inpatient Database (KID) The KID is a nationally representative sample, which allows for evaluation of VP-ID in a non-federal, non-Indian Health Service setting. In a cross-sectional analysis, we evaluated the association of race/ethnicity and a composite outcome of hospitalization due to vaccine-preventable infection using multivariate logistic regression. AI/AN children were more likely (OR = 1.81, 95% CI = 1.34, 2.45) to be admitted to the hospital in 2012 for a VP-ID compared to Non-Hispanic white children after adjusting for age, sex, chronic disease status, metropolitan location, and median household income. This disparity highlights the necessity for a more comprehensive understanding of immunization and infectious disease exposure among American Indian children, especially those not covered or evaluated by Indian Health Service.     

Association between iq’mik smokeless tobacco use and cardiometabolic risk profile among Yup’ik Alaska Native people

Objective: The traditional lifestyle of Yup’ik Alaska Native people, including a diet abundant in marine-based foods and physical activity, may be cardio-protective. However, iq’mik, a traditional form of smokeless tobacco used by >50% of Yup’ik adults, could increase cardiometabolic (CM) risk. Our objective was to characterize the associations between iq’mik use and biomarkers of CM status (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], systolic blood pressure [SBP] and diastolic blood pressure [DBP], glycated hemoglobin [HbA1c], fasting blood glucose [FBG], waist circumference [WC], and body mass index [BMI]).

Design: We assessed these associations using data from a cross-sectional sample of Yup’ik adults (n?=?874). Current iq’mik use, demographic, and lifestyle data were collected through interviews. Fasting blood samples were collected to measure LDL-C, HDL-C, TG, HbA1c, and FBG. SBP, DBP, WC, and BMI were obtained by physical examination. We characterized the association between current iq’mik use and continuous biomarkers of CM status using multiple approaches, including adjustment for measures of Yup’ik lifestyle and a propensity score.

Results: Based on either adjustment method, current iq’mik use was significantly and positively associated with at least 5% higher HDL-C, and significantly associated but in an inverse direction with multiple biomarkers of CM status including 7% lower TG, 0.05% lower HbA1c, 2% lower FBG, 4% lower WC, and 4% lower BMI. Observed associations for LDL-C, SBP, and DBP varied by adjustment method.

Conclusions: This inverse association between iq’mik use and cardiometabolic risk status has not been previously reported. Additional research is needed to replicate these findings and explore physiological mechanisms and/or confounding factors.     

Testis and antler dysgenesis in sitka black-tailed deer on Kodiak Island, Alaska: Sequela of environmental endocrine disruption?

It had been observed that many male Sitka black-tailed deer (Odocoileus hemionus sitkensis) on Kodiak Island, Alaska, had abnormal antlers, were cryptorchid, and presented no evidence of hypospadias. We sought to better understand the problem and investigated 171 male deer for phenotypic aberrations and 12 for detailed testicular histopathology. For the low-lying Aliulik Peninsula (AP), 61 of 94 deer were bilateral cryptorchids (BCOs); 70% of these had abnormal antlers. Elsewhere on the Kodiak Archipelago, only 5 of 65 deer were BCOs. All 11 abdominal testes examined had no spermatogenesis but contained abnormalities including carcinoma in situ-like cells, possible precursors of seminoma; Sertoli cell, Leydig cell, and stromal cell tumors; carcinoma and adenoma of rete testis; and microlithiasis or calcifications. Cysts also were evident within the excurrent ducts. Two of 10 scrotal testes contained similar abnormalities, although spermatogenesis was ongoing. We cannot rule out that these abnormalities are linked sequelae of a mutation(s) in a founder animal, followed by transmission over many years and causing high prevalence only on the AP. However, based on lesions observed, we hypothesize that it is more likely that this testis-antler dysgenesis resulted from continuing exposure of pregnant females to an estrogenic environmental agent(s), thereby transforming testicular cells, affecting development of primordial antler pedicles, and blocking transabdominal descent of fetal testes. A browse (e.g., kelp) favored by deer in this locale might carry the putative estrogenic agent(s).     

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included 1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.     

Effectiveness of the COVID-19 vaccines on preventing symptomatic SARS-CoV-2 infections and hospitalizations in Southwestern Alaska,January–December 2021

The population in rural southwest Alaska has been disproportionately affected by COVID-19. To assess the benefit of COVID-19 vaccines, we analyzed data from the regional health system. We estimated vaccine effectiveness (VE) during January 16–December 3, 2021, against symptomatic SARS-CoV-2 infection after a primary series or booster dose, and overall VE against hospitalization. VE of a primary series against symptomatic infection among adult residents was 91.3% (95% CI: 85.7, 95.2) during January 16–May 7, 2021, 50.3% (95% CI, 41.1%–58.8%) during July 17–September 24, and 37.0% (95% CI, 27.8–45.0) during September 25–December 3, 2021; VE of a booster dose during September 25–December 3, 2021, was 92.1% (95% CI: 87.2–95.2). During the overall study period, VE against hospitalization was 91.9% (95% CI: 85.4–95.5). COVID-19 vaccination offered strong protection against hospitalization and a booster dose restored protection against symptomatic infection.     

Enculturation,perceived stress,and physical activity: implications for metabolic risk among the Yup'ik – The Center for Alaska Native Health Research Study

Objectives. American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined.

Design. A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity.

Results. Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference.

Conclusions. Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.     

Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play?

OBJECTIVES: We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites. METHODS: We used data from the 1997 and 1999 National Survey of America's Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage. RESULTS: AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care. CONCLUSIONS: The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.     

Correlates of Overweight and Obesity Among American Indian/Alaska Native and Non-Hispanic White Children and Adolescents: National Survey of Children’s Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children’s Health, behavioral (child’s sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child’s bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child’s age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10–17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5–2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1–3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3–5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.