Pregnancy Outcomes of American Indians: Contrasts Among Regions and with Other Ethnic Groups

Objectives The two-fold purpose of this analysis is first to contrast the maternal risk factors and birth outcomes of American Indians (AIs) with other race/ethnic groups and to compare the maternal risk factors and birth outcomes of AIs by region to assess whether there are geographic variations in the adverse outcomes that might suggest intervention strategies. Study Design This study used the National Center for Health Statistics live birth infant death cohort files from 1995–2001. Singleton live births to U.S. resident mothers were selected. The analyses were limited to non-Hispanic American Indians, including Aleuts and Eskimos (n = 239,494), Non-Hispanic White (n = 15,488,133), and Hispanic births (n = 5,284,978). Results This comparison of birth characteristics and outcomes by ethnic group revealed that AIs have more adverse maternal risk factors (e.g., unmarried and <18 years of age) than Whites and Hispanics. After adjustment for these factors, AIs have higher risks of low birth weight and preterm birth and elevated risks of postneonatal and infant mortality. Their cause-specific rates for perinatal, SIDS, injury and infection are also higher. The regional analysis indicated the South/Northeast have more low birth weight and preterm problems, but the Mid-West has the highest risks of infant mortality among LBW infants gestational age-specific mortality rates, and mortality from SIDS. Conclusions These data show that AIs are not a homogenous group as evinced by distinct regional differences. SIDS is mainly a problem in the Mid-West, suggesting the involvement of environmental factors in that region. Further investigation is needed to examine the current AI perinatal health concerns.     

Obesity,Diabetes, and Birth Outcomes Among American Indians and Alaska Natives

Objectives To examine the relationships between prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), and prepregnancy body mass index, with several adverse birth outcomes: preterm delivery (PTB), low birthweight (LBW), and macrosomia, comparing American Indians and Alaska Natives (AI/AN) with other race/ethnic groups. Methods The sample includes 5,193,386 singleton US first births from 2009–2013. Logistic regression is used to calculate adjusted odds ratios controlling for calendar year, maternal age, education, marital status, Kotelchuck prenatal care index, and child’s sex. Results AI/AN have higher rates of diabetes than all other groups, and higher rates of overweight and obesity than whites or Hispanics. Neither overweight nor obesity predict PTB for AI/AN, in contrast to other groups, while diabetes predicts increased odds of PTB for all groups. Being overweight predicts reduced odds of LBW for all groups, but obesity is not predictive of LBW for AI/AN. Diabetes status also does not predict LBW for AI/AN; for other groups, LBW is more likely for women with DM or GDM. Overweight, obesity, DM, and GDM all predict higher odds of macrosomia for all race/ethnic groups. Conclusions for Practice Controlling diabetes in pregnancy, as well as prepregnancy weight gain, may help decrease preterm birth and macrosomia among AI/AN.     

Examining the Burdens of Gendered Racism: Implications for Pregnancy Outcomes Among College-Educated African American Women

Objectives: As investigators increasingly identify racism as a risk factor for poor health outcomes (with implications for adverse birth outcomes), research efforts must explore individual experiences with and responses to racism. In this study, our aim was to determine how African American college-educated women experience racism that is linked to their identities and roles as African American women (gendered racism). Methods: Four hundred seventy-four (474) African American women collaborated in an iterative research process that included focus groups, interviews, and the administration of a pilot stress instrument developed from the qualitative data. Analysis of the qualitative and quantitative data from the responses of a subsample of 167 college-educated women was conducted to determine how the women experienced racism as a stressor. Results: The responses of the women and the results from correlational analysis revealed that a felt sense of obligations for protecting children from racism and the racism that African American women encountered in the workplace were significant stressors. Strong associations were found between pilot scale items where the women acknowledged concerns for their abilities to provide for their children's needs and to the women's specific experiences with racism in the workplace (r = 0.408, p < .001). Conclusions: We hypothesize that the stressors of gendered racism that precede and accompany pregnancy may be risk factors for adverse birth outcomes.     

Defining Ethnic Enclave and Its Associations with Self-Reported Health Outcomes Among Asian American Adults in New York City

Evidence on ethnic enclave-health associations for Asian Americans is limited due to an inconsistent definition of ethnic enclave. The authors aimed to establish a robust criterion for defining Asian enclaves in New York City (NYC) and assessed the association between enclave residence and health outcomes among Asian American adults. Data came from 2009–2012 NYC Community Health Surveys and 2008–2012 American Community Survey. Asian enclave was defined as an area with high dissimilarity and isolation scores as well as high concentration of Asians. Five of 55 NYC community districts were identified as Asian enclaves. After controlling for confounding, enclave residence was associated with positive perception of general health with borderline significance (prevalence ratio = 1.06, 95 % CI 0.98, 1.15), but not with current smoking, hypertension, and diabetes. Ethnic enclave residence in urban areas may not produce a substantial impact on chronic health outcomes for Asian Americans beyond individual-level factors.     

Prevalence and Indicators of Household Smoking Bans Among American Indians

More than 58 million nonsmokers in the U.S. encounter secondhand smoke that leads to tobacco-related diseases and deaths every year, making voluntary household smoking bans an important public health goal. American Indians/Alaska Natives are rarely included in research related to household smoking bans. Further, most studies dichotomize household smoking bans into complete bans versus partial/no bans, rendering it impossible to determine if partial and no bans are associated with different or similar risk factors. Using the 2014 Cherokee Nation American Indian Adult Tobacco Survey, our study sought to identify prevalence of household smoking bans, their extent, and their correlates in an American Indian population. This cross-sectional analysis used multinomial logistic regression to determine correlates of complete, partial, and no household smoking bans. Results indicated that approximately 84% of Cherokee households have a complete ban. Younger age, female gender, higher education, higher household income, respondent’s nonsmoking status, good health, better awareness of harms related to secondhand smoke, visits with a healthcare provider within the past year, and children in the home were positively and significantly associated with complete household smoking bans. Additionally, there were notable differences between correlates related to partial bans and no bans. These results provide insight for the development of more appropriate interventions for American Indian households that do not have a complete household smoking ban.     

Physical Activity and Fruit and Vegetable Intake Among American Indians

The American Indian population has among the highest rates of obesity in the United States. Thus, it is critical to understand factors related to this epidemic (e.g., physical activity, nutrition) among this ethnic minority population. The current study examined factors related to engaging in at least 4 days of physical activity (PA) per week and factors related to consuming at least 5 fruits and vegetables (FV) per day among a sample of American Indians in the Midwest. We used multiple methods to recruit participants for this study, including recruitment at pow wows, focus groups, health fairs, new student orientation for American Indian students, and other venues. A total of 998 American Indians (76% participation rate) completed a survey assessing sociodemographics, physical activity level, fruit and vegetable intake, and perceptions regarding the recommendations for physical activity and fruit and vegetable intake. Factors associated with exercising ≥4 days in the past week (44.77% of the sample) include being younger (P = .002), being male (P < .001), having at least some college education (P = .048), eating ≥5 FV per day, and higher perceived number of days of PA recommended (P < .001). Factors associated with eating ≥5 servings of FV per day (37.01% of the sample) included exercising ≥4 days in the past week (P < .001) and higher perceived number of servings of FV recommended (P < .001). These findings highlight the importance of education in enhancing engagement in positive weight control behaviors and the importance of addressing both physical activity and nutrition among the American Indian population.     

Prevalence of Depression Symptoms Before and During the COVID-19 Pandemic Among Two Asian American Ethnic Groups

Journal of Immigrant and Minority Health - Asian Americans have experienced compounding stressors during the pandemic as a result of racial discrimination. We aim of to investigate the prevalence...     

Food Security and Diet Among American Indians in the Midwest

The purpose of this study was to determine levels of food security among American Indians (AI) living in the Midwest and possible correlations between food security levels and various health outcomes, diet, and demographic variables. This study used a cross-sectional design to determine health behaviors among AI. Participants (n?=?362) were recruited by AI staff through various cultural community events in the Midwest, such as powwows and health fairs. Inclusion criteria included the following: age 18 years or older, self-identify as an AI, and willing to participate in the survey. Of all participants, 210 (58%) had either low or very low food security, with 96 in the very low category (26.5%). Participants with very low food security tended to have significantly more chronic conditions. Additional significant differences for very low food security existed by demographic variables, including having no insurance (p?<?0.0001) or having a regular primary care provider (p?=?0.0354). There was also a significant difference between food security levels and the consumption of fast food within the past week (p value?=?0.0420), though no differences were found in fruit and vegetable consumption. AI in our sample had higher levels of food insecurity than those reported in the literature for other racial/ethnic groups. AI and non-Native health professionals should be aware of the gravity of food insecurity and the impact it has on overall health. Additional research is needed to determine specific aspects of food insecurity affecting different Native communities to develop appropriate interventions.     

Improving Maternal and Infant Child Health Outcomes with Community-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio

Maternal and Child Health Journal - Objectives To describe temporal changes in maternal and child health outcomes in an impoverished urban community after the implementation of an innovative...     

Determinants of Successful Treatment Outcomes Among a Sample of Urban American Indians/Alaska Natives: the Role of Social Environments

Very few studies have analyzed the role of social environments on substance abuse treatment outcomes among urban American Indians/Alaska Natives (AI/ANs). This study examined a measure of positive treatment response—abstinence from substance use at treatment discharge—among urban AI/ANs in Los Angeles County. The sample included all AI/ANs in outpatient drug-free (e.g., no methadone) treatment and residential treatment from 2004 to 2008 (N?=?811). Predictors of abstinence at discharge were (a) having recovery-oriented social support and (b) not having a difficult living situation (i.e., experiencing family conflict and/or living with someone who uses alcohol and/or drugs). Higher levels of recovery-oriented social support in the past 30 days predicted abstinence during outpatient treatment. In residential treatment, retention of 90 days or more, high recovery-oriented social support, and not experiencing difficult living situations predicted abstinence. Suggestions for optimizing treatment outcomes among AI/ANs and areas of further research are provided.     

Pregnancy Outcomes Among Women with Homozygous Hemoglobin E Disease: A Retrospective Cohort Study

Background Homozygous hemoglobin E (HbE) disease is common, especially in Southeast Asia where the prevalence may be as high as nearly 1 % of pregnancies and it is usually associated with mild anemia. Nevertheless, the effects of the disease on pregnancy outcomes have never been explored. Objective To compare the obstetric adverse outcomes between singleton pregnancies complicated with HbE disease and normal controls. Patients and Methods A retrospective cohort study was undertaken by assessment of the database of maternal–fetal medicine units, Chiang Mai University, Thailand, from January 2000 to December 2014 to search for the records of pregnant women complicated by the disease. The records of low risk pregnancies were randomly selected as a control group with a ratio of 10:1. Pregnancies with underlying medical diseases or fetal abnormalities as well as those with no complete data were excluded. Result During the study period, 78 women with homozygous HbE disease (study group) and 780 normal controls were recruited. Most baseline characteristics of the two groups were similar. The mean birth weight was significantly lower in the study group (2683 ± 627 vs 2925 ± 623 g, P = 0.001).The prevalence of fetal growth restriction was also significantly higher in the study group (13.2 vs 6.7 %, P = 0.040, relative risk 1.96; 95 % CI 1.04–3.69), whereas the rates of other outcomes such as preterm birth were comparable. Conclusion for Practice Homozygous HbE disease does not increase risk of common adverse pregnancy outcomes, but it significantly increases risk of fetal growth restriction, resulting in significantly lower mean birth weight.     

Outcomes of drug and alcohol treatment programs among American Indians in California

OBJECTIVES: We examined differences in substance abuse treatment outcomes between American Indians and their non-American Indian counterparts in California, during 2000 to 2002. METHODS: A total of 368 American Indians and a matched sample of 368 non-American Indians from 39 substance abuse treatment programs in 13 California counties were assessed at multiple time points. Records on arrests, driving while under the influence of alcohol or drugs, and mental health care were obtained 1 year before and 1 year after treatment entry. Differences in pretreatment characteristics, services received, treatment satisfaction, treatment completion and retention, and outcomes were examined. RESULTS: Pretreatment problems were similarly severe among American Indians and non-American Indians. About half in both groups either completed treatment or stayed in treatment more than 90 days; American Indians in residential care had significantly shorter treatment retention. American Indians received fewer individual sessions and out-of-program services, especially for alcohol abuse, but were nevertheless generally satisfied with their treatment. Both groups improved after treatment, with American Indians demonstrating greater reductions in arrests than non-American Indians. CONCLUSION: American Indians benefit from substance abuse treatment programs, although the type and intensity of services offered could be improved.     

Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions

Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community’s perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.     

The Impact of Migration on Pregnancy Outcomes Among Mexican-Origin Women

To examine the association between individual-level and state-level migration status in the United States (US) and the risk of preterm and low birth weight infants among Mexican-origin women. We performed secondary analysis of the 2003 US birth certificate data for 641,474 infants born to Mexican-origin Latina women. The dependent variables were prematurity and low birth weight. The primary independent variables were individual- (maternal) and state-level migration status. Logistic regression analysis estimated the relationship between maternal and state-level migration status, maternal and infant factors, and the risk of prematurity and low birth weight. Women who were born in Mexico had less education and use of prenatal care than US-born, Mexican-origin women but also fewer preterm or low birth weight infants. After adjusting for maternal and infant characteristics, women who were born and resided in Mexico at delivery were 37–64 % less likely to deliver preterm or low birth weight infants, and women who were born in Mexico and resided in the US had a 20–21 % lower risk as compared to women who were born and resided in the same US state. Women who delivered in states with a higher proportion of Mexican-origin mothers were slightly more likely to deliver a preterm infant and slightly less likely to give birth to a low birth weight infant. These findings support the perinatal advantage of Mexican-born women and provide evidence that both individual- as well as state-level migration factors influence perinatal outcomes.