Abstract
Alaska Native people experience disparities in mortality from heart disease and stroke. This work attempts to better understand the relationships between socioeconomic, behavioral, and cardiometabolic risk factors among Yup’ik people of southwestern Alaska, with a focus on the role of the socioeconomic, and cultural components. Using a cross-sectional sample of 486 Yup’ik adults, we fitted a Partial Least Squares Path Model (PLS-PM) to assess the associations between components, including demographic factors [age and gender], socioeconomic factors [education, economic status, Yup’ik culture, and Western culture], behavioral factors [diet, cigarette smoking and smokeless tobacco use, and physical activity], and cardiometabolic risk factors [adiposity, triglyceride-HDL and LDL lipids, glycemia, and blood pressure]. We found relatively mild associations of education and economic status with cardiometabolic risk factors, in contrast with studies in other populations. The socioeconomic factor and participation in Yup’ik culture had potentially protective associations with adiposity, triglyceride-HDL lipids, and blood pressure, whereas participation in Western culture had a protective association with blood pressure. We also found a moderating effect of participation in Western culture on the relationships between Yup’ik culture participation and both blood pressure and LDL lipids, indicating a potentially beneficial additional effect of bi-culturalism. Our results suggest that reinforcing protective effects of both Yup’ik and Western cultures could be useful for interventions aimed at reducing cardiometabolic health disparities.
Highlights
Over the last three decades, attention to social determinants of health among indigenous communities have focused on individual and community social stressors that stem from the marginal place of indigenous communities in the current global political economy [1,2,3,4,5]
We found significant paths afferent to some of the cardiometabolic risk components: (1) subsistence food had a positive association with LDL lipids; (2) smokeless tobacco and physical activity had inverse associations with adiposity; and (3) adiposity had positive associations with all other cardiometabolic risk components
The positive slope for lowest level of Western culture is not as steep as the one of LDL Lipids, indicating a weaker association between Yup’ik cultural participation and blood pressure than with LDL Lipids for lowest levels of Western culture. Most of these results point to complex associations between culture, behavior, and cardiometabolic health
Summary
Over the last three decades, attention to social determinants of health among indigenous communities have focused on individual and community social stressors that stem from the marginal place of indigenous communities in the current global political economy [1,2,3,4,5]. This research focused on the discovery and examination of “risk factors” that influenced individual health outcomes [6,7,8]. Across the Arctic, culture-focused health interventions contend with a legacy of past, deleterious state-inspired programs such as community relocation and sedentarization [15,16,17,18]. These programs, originally intended to promote assimilation and the incorporation of Inuit/ Inupiat/Yup’ik peoples in larger national political economies, have resulted in a well-known list of social ills, such as broken family ties or loss of language [19,20,21]. Emerging literature on ‘cultural-based protective factors’ in the region has focused on the potential for cultural participation to mitigate negative outcomes associated with this history [22], including suicide [23,24], substance abuse [19,25,26], Type 2 diabetes [27], depression [4,28] and other mental health outcomes [29,30]
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