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.     

Use of a food frequency questionnaire in American Indian and Caucasian pregnant women: a validation study

Background  

Food frequency questionnaires (FFQs) have been validated in pregnant women, but few studies have focused specifically on low-income women and minorities. The purpose of this study was to examine the validity of the Harvard Service FFQ (HSFFQ) among low-income American Indian and Caucasian pregnant women.     

An assessment of American Indian women's mammography experiences

Background  

Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey.     

Inequalities in cesarean births between American Indian & Alaska Native people and White people

Objective

To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors.

Data Sources and Study Setting

We used birth certificate data inclusive of all live births within the United States between January 1 and December 31, 2017.

Study Design

We calculated propensity score weights that simultaneously incorporate age, cesarean indication, and clinical and obstetric risk factors to estimate the American Indian and Alaska Native-White inequality.

Data Collection/Extraction Methods

Births to individuals identified as American Indian, Alaska Native, or White, and residing in one of the 50 US states or the District of Columbia were included. Births were excluded if missing maternal race/ethnicity or any other covariate.

Principal Findings

After weighing the American Indian and Alaska Native obstetric population to be comparable to the distribution of cesarean indication, age, and clinical and obstetric risk factors of the White population, the cesarean incidence among American Indian and Alaska Natives increased to 33.4% (95% CI: 32.0–34.8), 3.2 percentage points (95% CI: 1.8–4.7) higher than the observed White incidence. After adjustment, cesarean birth incidence remained higher and increased in magnitude among American Indian and Alaska Natives in Robson groups 1 (low risk, primary), 6 (nulliparous, breech presentation), and 9 (transverse/oblique lie).

Conclusions

The unadjusted lower cesarean birth incidence observed among American Indian and Alaska Native individuals compared to White individuals may be related to their younger mean age at birth. After adjusting for this demographic difference, we demonstrate that American Indian and Alaska Native individuals undergo cesarean birth more frequently than White individuals with similar risk profiles, particularly within the low-risk Robson group 1 and those with non-cephalic presentations (Robson groups 6 and 9). Racism and bias in clinical decision making, structural racism, colonialism, or other unidentified factors may contribute to this inequality.     

Alcohol consumption and the risk of coronary heart disease in postmenopausal women with diabetes: Women’s Health Initiative Observational Study

Background  

Although several observational studies have consistently reported an inverse association between moderate alcohol consumption and risk of coronary heart disease (CHD), it is yet not well established if this association also exists among people with type 2 diabetes. The aim of this study is to evaluate the association between the frequency and quantity of alcohol intake and the risk of developing CHD among postmenopausal women with diabetes.     

Engaging diverse underserved communities to bridge the mammography divide

Background  

Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations.     

Elevated rates of HIV infection among young Aboriginal injection drug users in a Canadian setting

Objectives  

Recent reports have suggested that Aboriginal and American Indian people are at elevated risk of HIV infection. We undertook the present study to compare socio-demographic and risk variables between Aboriginal and non-Aboriginal young (aged 13 – 24 years) injection drug users (IDUs) and characterize the burden of HIV infection among young Aboriginal IDUs.     

Behavioral symptoms of eating disorders in Native Americans: results from the ADD Health Survey Wave III

Objective:

To examine prevalence and correlates (gender, Body Mass Index) of disordered eating in American Indian/Native American (AI/NA) and white young adults.

Method:

We examined data from the 10,334 participants (mean age 21.93 years, SD = 1.8) of the National Longitudinal Study of Adolescent Health (ADD Health) Wave III for gender differences among AI/NA participants (236 women, 253 men) and ethnic group differences on measures of eating pathology.

Results:

Among AI/NA groups, women were significantly more likely than men to report loss of control and embarrassment due to overeating. In gender‐stratified analyses, a significantly higher prevalence of AI/NA women reported disordered eating behaviors compared with white women; there were no between group differences in prevalence for breakfast skipping or having been diagnosed with an eating disorder. Among men, disordered eating behaviors were uncommon and no comparison was statistically significant.

Discussion:

Our study offers a first glimpse into the problem of eating pathology among AI/NA individuals. Gender differences among AI/NA participants are similar to results reported in white samples. That AI/NA women were as likely as white women to have been diagnosed with an eating disorder is striking in light of well documented under‐utilization of mental health care among AI/NA individuals. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2011)     

The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review

Background  

In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship.     

Peer Reviewed: Differences in Patterns of Alcohol Consumption Among Hispanics in the United States,by Survey Language Preference,Behavioral Risk Factor Surveillance System, 2005

Introduction

Alcohol consumption is pervasive in the United States, and extent of alcohol consumption for the growing US Hispanic population needs further study. We examined the association between language chosen for a national health survey and alcohol use among Hispanic adults.

Methods

Hispanic participants aged 18 years and older (N = 20,234) from the 2005 Behavioral Risk Factor Surveillance System were stratified by choice of language (English, n = 13,035; Spanish, n = 7,199) for completing the survey. Differences for these 2 groups in current alcohol use, heavy alcohol use, and binge drinking were determined by using χ² analyses and logistic regression models.

Results

In bivariate associations, current drinking (P < .001), heavy drinking (P < .001), and binge drinking (P = .002) were significantly higher among participants who chose to complete the survey in English than among those who elected to complete the survey in Spanish. After controlling for demographic characteristics, associations between language choice and drinking behaviors were found to be greatest among women. Compared with women who chose to complete the survey in Spanish, women who chose to complete the survey in English were more than twice as likely to report current drinking (odds ratio [OR] = 2.42, 95% confidence interval [CI] = 2.02-2.91), heavy drinking (OR = 3.82, 95% CI = 1.44-10.10), and binge drinking (OR = 2.51, 95% CI = 1.64-3.84).

Conclusion

This study suggests that language choice when completing a health survey is a predictor of high levels of alcohol use among Hispanic adults in the United States and that differences in drinking behaviors based on language choice for a survey are more profound among women.     

Vital Signs: Binge Drinking Among Women and High School Girls — United States, 2011

Background

Excessive alcohol use accounted for an estimated average of 23,000 deaths and 633,000 years of potential life lost (YPLL) among women and girls in the United States each year during 2001–2005. Binge drinking accounted for more than half of those deaths and YPLL. Binge drinking also is a risk factor for many health and social problems among women and girls, including unintended and alcohol-exposed pregnancy, sexually transmitted diseases, and breast cancer.

Methods

To describe the prevalence, frequency, and intensity of binge drinking (four or more drinks on an occasion in the last 30 days) among U.S. women aged ≥18 years, CDC analyzed data from the 2011 Behavioral Risk Factor Surveillance System. Data were also analyzed from the 2011 national Youth Risk Behavior Survey on the prevalence of current alcohol use (one or more drinks during the past 30 days) and binge drinking (five or more drinks in a row during the past 30 days) among U.S. high school girls in grades 9–12.

Results

Among adult women, the prevalence of binge drinking was 12.5%, and among those who binge drank, the frequency of binge drinking was 3.2 episodes per month and the intensity was 5.7 drinks on occasion. Binge drinking was most prevalent among women aged 18–24 years (24.2%) and 25–34 years (19.9%), and among those from households with annual incomes of ≥$75,000 (16.0%). Among those who binge drank, women aged 18–24 years had the highest frequency (3.6 episodes) and intensity (6.4 drinks) of binge drinking. Among high school girls, the prevalence of current alcohol use was 37.9%, the prevalence of binge drinking was 19.8%, and the prevalence of binge drinking among girls who reported current alcohol use was 54.6%.

Conclusions

Binge drinking is reported by one in eight U.S. adult women and one in five high school girls. Women who binge drink tend to do so frequently and with high intensity. Most high school girls who reported current alcohol use also reported binge drinking.

Implications for Public Health Practice

More widespread implementation of evidence-based interventions, such as those recommended by the Guide to Community Preventive Services and the U.S. Preventive Services Task Force, would be expected to reduce the frequency and intensity, and ultimately the prevalence of binge drinking among women and girls, and the harms related to it.     

Strategies to prevent HIV transmission among heterosexual African-American women

Background  

African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women.     

Alcohol Consumption and Mortality: The Khon Kaen Cohort Study,Thailand

Background

The prevalence of alcohol consumption among Thais is high, around 30%. We quantified the relationship between alcohol drinking and mortality in a rural population in the most populous region of Thailand.

Methods

The data were from the Khon Kaen Cohort Study. About 24 000 Thai adults were enrolled between 1990 and 2001, and follow-up for vital status continued until March 16, 2012. Mortality data were obtained from the Bureau of Policy and Strategy, Ministry of the Interior, Thailand. A Cox proportional hazards model was used to analyze the association between alcohol drinking and death, controlling for age, education level, and smoking, and floating absolute risk was used to estimate the 95% confidence intervals of hazard ratios.

Results

In total, 18 457 participants (5829 men and 12 628 women) were recruited, of whom 3155 died (1375 men and 1780 women) during a median follow-up period of 13.6 years. Although alcohol drinking was common (64% of men and 25% of women), the amounts consumed were very low (average, 4.3 g/day in men and 0.8 g/day in women). As compared with never drinkers, mortality risk was lower among current drinkers and higher among ex-drinkers. Current drinking was not associated with mortality from cancer or diseases of the circulatory system, although ex-drinkers appeared to have a higher risk of death from the latter.

Conclusions

The leading causes of mortality were not associated with current alcohol drinking at the low consumption levels observed in this population.Key words: alcohol consumption, mortality, health behaviour, rural population     

Influence of Health Care, Cost, and Culture on Breast Cancer Screening: Issues Facing Urban American Indian Women

Background. Breast cancer is the second leading cause of cancer death among American Indian women. Southwestern American Indian women are more likely to have distant spread of the disease, and 5-year survival from breast cancer is poor in comparison to U.S. whites. Mortality from breast cancer could be reduced by more than 30% in American Indian women if current recommendations for screening were followed.Methods. A random household cross-sectional survey was conducted among 519 adult American Indian women in Phoenix, Arizona. Logistic regression was used to identify predictors of recent clinical breast examination and mammogram among those women aged 40 years and older.Results. Just more than half (53.0%) of the women surveyed reported they had received a clinical breast examination in the last year, and 35.7% indicated they had received a mammogram in the last 2 years. Access to care, knowledge of the examinations, and health beliefs were positively associated with breast cancer screening in the multivariate analyses.Conclusions. The cancer screening rates observed in urban American Indian women are far below current national estimates and Healthy People 2000 Objectives. This study confirms the limited access of urban Indians to preventive health services, and supports a role for cancer education in improving screening participation in this special population.     

An Ongoing Burden: Chlamydial Infections among Young American Indian Women

Objectives Studies conducted in the 1980s, when there was limited chlamydia screening, showed high positivity, 23%–30%, among American Indian women. In the 1990s, chlamydia screening and treatment programs were implemented in a variety of settings serving American Indian women including Indian Health Service (IHS) clinics. Yet, a 2000–2001 national survey documented a chlamydia prevalence of 13.3% among young American Indian women, five times higher than the prevalence among whites. The purpose of this analysis was to determine the chlamydia positivity and risk factors for chlamydia among women screened in Indian Health Service (IHS) clinics participating in the National Infertility Prevention Program in 2003. Methods Data were analyzed from 11,485 chlamydia tests performed among women universally screened in 23 IHS clinics in three states (Montana, North Dakota, South Dakota). Sexual risk history and clinical data were collected in the Montana IHS clinics and used to assess risk factors for chlamydial infection in a multivariate logistic regression model. Results Chlamydia positivity was highest among 15–19 year old women screened in IHS clinics (state range: 15.3%–18.6%). Positivity decreased with age but remained high even among women aged 30–34 years. Young age and having had multiple or new sex partners in the last 90 days were associated with an increased risk of chlamydia; however, chlamydia positivity was greater than 6.7% for women with no known risk factors. Conclusions A greater emphasis on chlamydia screening and treatment should be a component of any program whose goal is to improve the reproductive health of American Indian women.     

Peer Reviewed: Anthropometric Measures,Presence of Metabolic Syndrome,and Adherence to Physical Activity Guidelines Among African American Church Members,Dallas, Texas, 2008

Introduction

The low prevalence of physical activity among African Americans and high risk of cardiovascular disease lends urgency to assessing the association between metabolic syndrome, abdominal obesity, and adherence to current physical activity guidelines. Few studies have examined this association among African American adults.

Methods

We examined the association between demographic characteristics, anthropometric measures, and metabolic syndrome and adherence to the 2008 Department of Health and Human Services guidelines for moderate and vigorous physical activity. Participants were 392 African American church members from congregations in Dallas, Texas. Physical activity levels were assessed via a validated questionnaire (7-Day Physical Activity Recall), and metabolic syndrome was determined on the basis of the American Heart Association/National Heart, Lung, and Blood Institute diagnostic criteria. We used bivariate and multinomial logistic regression to examine the associations.

Results

Meeting guidelines for vigorous physical activity was significantly and independently associated with the absence of metabolic syndrome among women (odds ratio, 4.71; 95% confidence interval, 1.63-13.14; P = .003), after adjusting for covariates. No association was found between meeting moderate or vigorous physical activity guidelines and metabolic syndrome among men. Meeting physical activity guidelines was not associated with body mass index or waist circumference among this sample of predominantly overweight and obese African American church members.

Conclusion

Results indicate that meeting the 2008 guidelines for vigorous physical activity is associated with the absence of metabolic syndrome among African American women. This finding might suggest the need to integrate vigorous physical activity into interventions for African American women as a preventive therapy for cardiovascular risk.      

Targeting young drinkers online: the effectiveness of a web-based brief alcohol intervention in reducing heavy drinking among college students: study protocol of a two-arm parallel group randomized controlled trial

Background  

The prevalence of heavy drinking among college students and its associated health related consequences highlights an urgent need for alcohol prevention programs targeting 18 to 24 year olds. Nevertheless, current alcohol prevention programs in the Netherlands pay surprisingly little attention to the drinking patterns of this specific age group. The study described in this protocol will test the effectiveness of a web-based brief alcohol intervention that is aimed at reducing alcohol use among heavy drinking college students aged 18 to 24 years old.     

Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females

African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14–20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.