American Indian Adults Research Articles

Relationship Between Urinary Uranium and Cardiac Geometry and Left Ventricular Function: The Strong Heart Study

BackgroundUranium is a potentially cardiotoxic, nonessential element commonly found in drinking water throughout the United States. ObjectivesThe purpose of this study was to evaluate if urinary uranium concentrations were associated with measures of cardiac geometry and function among American Indian young adults from the Strong Heart Family Study. MethodsUrinary uranium was measured among 1,332 participants free of diabetes, cardiovascular disease, and <50 years of age at baseline (2001-2003). Transthoracic echocardiography and blood pressure were assessed at baseline and at a follow-up visit (2006-2009). We estimated adjusted mean differences in cardiac geometry and function measures at baseline and follow-up using linear mixed-effect models with a random intercept and slope over time. ResultsMedian (interquartile range) uranium was 0.029 (0.045) μg/g creatinine. In fully adjusted cross-sectional models, a log-doubling of urinary uranium was positively associated with left ventricular (LV) mass index (mean difference: 0.49 g/m2, 95% CI: 0.07-0.92 g/m2), left atrial systolic diameter (0.01 cm/m2, 0.01-0.02 cm/m2), and stroke volume (0.66 mL, 0.25-1.08 mL) at baseline. Prospectively, uranium was associated with increases in left atrial diameter (0.01 cm/m2, 0.01-0.02 cm/m2), pulse pressure (0.28 mm Hg, 0.05-0.52 mm Hg), and incident LV hypertrophy (odds ratio: 1.25, 95% confidence interval: 1.06, 1.48). ConclusionsUrinary uranium levels were adversely associated with measures of cardiac geometry and LV function among American Indian adults, including increases in pulse pressure and LV hypertrophy. These findings support the need to determine the potential long-term subclinical and clinical cardiovascular effects of chronic uranium exposure, and the need for future strategies to reduce exposure.

COVID-19 Pandemic Coping, Social Support, and Emotional Health in American Indian and Alaska Native Peoples

The COVID-19 pandemic has placed a burden on the health of many people, including significant disparities in American Indian and Alaska Native communities. This study examines the associations between coping behaviors, social support, and emotional health among American Indian and Alaska Native peoples during the COVID-19 pandemic. This cross-sectional study included survey data collected from November 2021 to May 2022 from American Indian and Alaska Native adults aged 18 years or older without dementia or other serious cognitive impairments who were seen at 6 urban health organizations primarily in urban settings (in New Mexico, Alaska, Colorado, Minnesota, Utah, and Kansas) in the year prior to the survey. Exposures of interest included avoidant and direct problem-solving coping behaviors and functional and emotional social support. The study outcome was self-reported change in emotional health since COVID-19 pandemic onset. Poisson regression was used to model adjusted multivariate associations. Data were weighted to account for age, nonresponse, and disproportionate representation by clinic population. A total of 1164 participants were included in the analysis, with a mean (SD) age of 42.5 (13.4) years; 830 (61%, weighted sample percentage) were female. Since COVID-19 pandemic onset, 465 patients (39% weighted) reported worsened emotional health. Problem-solving coping mean (SD) utilization score was 2.5 (0.5), avoidant coping mean (SD) utilization score was 2.3 (0.5), mean (SD) functional social support score was 11.4 (2.9), and 219 participants (18% weighted) reported that emotional support was always available. Using problem-solving coping skills was associated with better emotional health (adjusted prevalence ratio [APR], 0.66 [95% CI, 0.54-0.81] for highest vs lowest tertile), as was always (vs never or rarely) getting emotional support (APR, 0.40; 95% CI, 0.30-0.55) and having more functional support (APR, 0.90 [95% CI, 0.87-0.92] per 1-unit increase in functional social support). In examination of psychological resilience potentially modifying primary exposure associations, no interactions were statistically significant. In this cross-sectional study of urban American Indian and Alaska Native peoples, problem-solving coping skills and more social support were associated with better emotional health during the COVID-19 pandemic. These findings can be used to identify strengths-based approaches to support community emotional health during social upheavals.

Abstract PR005: Preliminary findings from the North Carolina American Indian Adult Tobacco Survey

Abstract INTRODUCTION: Commercial tobacco use remains a leading contributor to the cancer burden in the United States and disproportionately affects historically marginalized communities including American Indian adults. National surveys estimate the current cigarette smoking prevalence for American Indian adults is 27%; however, state-level and tribe-specific data are limited. North Carolina is home to seven state-recognized tribes, one federally-recognized tribe, and four Urban Indian Organizations with ∼130,000 residents identifying as American Indian. We conducted a commercial tobacco use survey with and for tribal communities in NC to assess overall use among American Indian residents and by tribal affiliation. Here, we present preliminary findings for the North Carolina American Indian Adult Tobacco Survey (NCAIATS), a collaboration between the NC Commission of Indian Affairs, the NC Tobacco Prevention and Control Branch, and the Southeastern American Indian Cancer Health Equity Partnership. METHODS: We administered the NCAIATS as an online REDCap survey with recruitment occurring primarily by trusted tribal members during tribal community events (e.g., Pow Wows, culture classes). Data collection remains ongoing but results reported below are from July 2023-March 2024. Survey completion took 10-15 minutes and respondents could receive $25 for participation. The NCAIATS, adapted from the CDC’s American Indian Adult Tobacco Survey, assesses use of commercial products including cigarettes, cigars, e-cigarettes and smokeless tobacco as well as knowledge about tobacco-relevant cancer screenings (e.g., low dose computed tomography scans for lung cancer). RESULTS: N=2,096 American Indian adults living in NC completed the survey with representation from all NC tribes as well as 34 other North American tribes. The sample is 66.8% female with a mean age of 41.0 (SD=15.5) and 28.3% reported a bachelor’s degree or higher for educational attainment. When reporting ever use of commercial products (defined as either ‘even 1-2 puffs’ or ‘even 1 time’), 67.0% of respondents reported ever use of cigarettes, 38.5% reported ever use of cigars, 31.6% reported ever use of e-cigarettes and 19.8% reported ever use of smokeless tobacco. When reporting current use of commercial products (defined as ‘every day’ and ‘some days’), 28.1% reported current cigarette use, 13.7% reported current cigar use, 15.4% reported current e-cigarette use and 7.3% reported current smokeless tobacco use. Finally, only 45.3% of respondents, including 48.3% of current cigarette smokers, reported ever hearing of lung cancer screening. CONCLUSIONS: Commercial tobacco use is common among a broad representation of American Indian adults living in NC. Our preliminary results for current cigarette smoking rates align with national prevalence estimates, indicating critical need for additional prevention and cessation resources for this population. Further, more work is needed to inform American Indian residents of NC about the availability of lung cancer screening and the benefits of early detection. Citation Format: Rachel Denlinger-Apte, Tomi Akinyemiju, Ronny Bell, Laury Chavis, Ralph D’Agostino Jr., Emily Harwood, Courtney Heck, Sally Herndon, Kayla Hicks, Charlene Hunt, Candace Lowry, Lu McCraw, Greg Richardson, Stephanie Wheeler, Alana Willis. Preliminary findings from the North Carolina American Indian Adult Tobacco Survey [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR005.

Abstract B091: Listen, Empower, Co-Create: Conducting listening sessions to create tailored messages about colorectal health for American Indian communities

Abstract Background We conducted Listening Sessions using a modified version of boot camp translation (BCT), a validated community engaged approach, to engage American Indian community members in the Great Plains and the Pacific Northwest to develop culturally and locally relevant colorectal cancer (CRC) screening messages and materials. Methods CRC is one of the leading causes of cancer death in the US and disproportionally affects American Indian adults. Routine CRC screening leads to earlier diagnosis and prolonged survival from the disease. In partnership with Great Plains Tribal Leaders Health Board (GPTLHB), South Puget Intertribal Planning Agency (SPIPA), and National Association of Chronic Disease Directors, we used a modified BCT approach to obtain feedback from tribal communities to create CRC screening messages and materials. To make the BCT process more meaningful for our partner communities, we reframed the BCT sessions by referring to them as Listening Sessions. The Listening Session engagement process was designed to help community leaders and champions learn about local barriers and gaps in care (listen), share health information in a collaborative way (empower), and develop messages and materials that resonate with and motivate community members to take control of their health (co-create). Eligible tribal community members from GPTLHB and SPIPA were between the ages of 45-75 and able to participate in three Listening Session meetings (one five-hour in-person meeting including expert presentations, brainstorming opportunities, and interactive small group sessions, and two follow-up virtual sessions (one-hour each) to refine messages and materials). Results Common Themes. Both groups emphasized the importance of using a multigenerational approach by including grandchildren and Elders in the messages and materials. Additionally, they highlighted the need for materials to be relatable and culturally relevant by incorporating local cultural imagery and traditions and multigenerational family support .Differing Themes. The GPTLHB findings focused specifically on including Lakota words to reinforce cultural identity, using visuals for colon health education, and incorporating details about healing traditions. The SPIPA findings recommended highlighting intertribal milestones like the canoe journey and incorporating water as a symbol of spiritual healing. Materials and Dissemination Methods. Preferred materials and channels for dissemination were: 1) fact sheets, posters, and visual stories to be distributed in-clinic or at community events, 2) animated videos for CRC screening education to be shown in clinic, 3) live action videos with community member CRC stories to be shown in clinic. Final materials will be available here: www.KPCHR-engage.org Conclusion We conducted Listening Sessions to incorporate participant feedback to develop CRC screening messages and materials and identified preferred dissemination channels for tribal communities in the Great Plains and Pacific Northwest. Citation Format: Jamie Thompson, Jennifer Rivelli, Priyanka Gautom, LaToya Brave Heart, Jamie Nikander, Lorrie Graaf, Gloria Coronado. Listen, Empower, Co-Create: Conducting listening sessions to create tailored messages about colorectal health for American Indian communities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B091.

Asthma and Obstructive Sleep Apnea Overlap in a Sample of Older American Indian Adults: The Strong Heart Study.

Study Objectives: Our study aimed to investigate the association between asthma and obstructive sleep apnea (OSA) in American Indian communities, a historically underrepresented population in clinical research with a high prevalence of asthma and OSA risk factors like smoking and obesity. Methods: This cross-sectional study used data retrieved from the Strong Heart Study cohort. Participants who attended both the Asthma Sub-study and the Sleep Heart Health Study around the same time were compared for active asthma diagnosis, OSA diagnosis, and potential risk factors for asthma and OSA. The association between asthma and OSA was then evaluated. Results: Among the 2480 participants who attended the Strong Heart Study Phase III exam, 123 participated in both the Asthma Sub-study and the Sleep Heart Health Study. Of these, 13 were diagnosed with OSA, with 4 having moderate to severe OSA. There was no statistically significant difference in OSA prevalence between the active asthma group and the non-active asthma group (former asthma or no asthma) (9.6% vs. 12.5%, p = 0.63). Additionally, body mass index did not differ significantly between participants with both active asthma and OSA and those without active asthma, OSA, or both. OSA diagnosis was significantly associated with male sex (Odds Ratio [OR] 9.2 [1.85-45.87], p = 0.007) and body mass index (OR 1.1 [1.02-1.26], p = 0.016) but not with age or a diagnosis of active asthma. Conclusions: In this American Indian cohort, no significant difference in OSA prevalence was observed between participants with and without active asthma, contradicting previous studies. Further research is needed to explore the underlying reasons for this discrepancy.

Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016-2020.

Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations. Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record. This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45-64. Females were 1.2 times (95% confidence interval: 1.1-1.2) more likely than males to have a medical visit with an ADRD diagnosis code. Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45-64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

An epigenome-wide study of selenium status and DNA methylation in the Strong Heart Study

BackgroundSelenium (Se) is an essential nutrient linked to adverse health endpoints at low and high levels. The mechanisms behind these relationships remain unclear and there is a need to further understand the epigenetic impacts of Se and their relationship to disease. We investigated the association between urinary Se levels and DNA methylation (DNAm) in the Strong Heart Study (SHS), a prospective study of cardiovascular disease (CVD) among American Indians adults. MethodsSelenium concentrations were measured in urine (collected in 1989–1991) using inductively coupled plasma mass spectrometry among 1,357 participants free of CVD and diabetes. DNAm in whole blood was measured cross-sectionally using the Illumina MethylationEPIC BeadChip (850 K) Array. We used epigenome-wide robust linear regressions and elastic net to identify differentially methylated cytosine-guanine dinucleotide (CpG) sites associated with urinary Se levels. ResultsThe mean (standard deviation) urinary Se concentration was 51.8 (25.1) μg/g creatinine. Across 788,368 CpG sites, five differentially methylated positions (DMP) (hypermethylated: cg00163554, cg18212762, cg11270656, and hypomethylated: cg25194720, cg00886293) were significantly associated with Se in linear regressions after accounting for multiple comparisons (false discovery rate p-value: 0.10). The top hypermethylated DMP (cg00163554) was annotated to the Disco Interacting Protein 2 Homolog C (DIP2C) gene, which relates to transcription factor binding. Elastic net models selected 425 hypo- and hyper-methylated DMPs associated with urinary Se, including three sites (cg00163554 [DIP2C], cg18212762 [MAP4K2], cg11270656 [GPIHBP1]) identified in linear regressions. ConclusionsUrinary Se was associated with minimal changes in DNAm in adults from American Indian communities across the Southwest and the Great Plains in the United States, suggesting that other mechanisms may be driving health impacts. Future analyses should explore other mechanistic biomarkers in human populations, determine these relationships prospectively, and investigate the potential role of differentially methylated sites with disease endpoints.

Extracellular Vesicle-Encapsulated microRNAs and Respiratory Health Among American Indian Participants in the Strong Heart Study

American Indian populations have experienced marked disparities in respiratory disease burden. Extracellular vesicle-encapsulated microRNAs (EV-miRNAs) are a novel class of biomarkers that may improve recognition of lung damage in indigenous populations in the United States. Are plasma EV-miRNAs viable biomarkers of respiratory health in American Indian populations? The Strong Heart Study is a prospective cohort study that enrolled American Indian patients aged 45 to 74 years. EV-miRNA expression was measured in plasma (1993-1995). Respiratory health outcomes, including prebronchodilator FEV1, FVC, and respiratory symptom burden, were ascertained in the same study visit. Club cell secretory protein (CC-16), an antiinflammatory pneumoprotein implicated in COPD pathogenesis, was measured in serum. Linear and logistic regression were used for statistical analyses. Biological pathway analyses were used to elucidate gene targets of significant EV-miRNAs. Among 853 American Indian adults, three EV-miRNAs were associated with FEV1, four EV-miRNAs were associated with FVC, and one EV-miRNA was associated with FEV1/FVC (P< .05). Increased miR-1294 expression was associated with higher odds of airflow limitation (OR, 1.29; 95%CI, 1.07-1.55), whereas increased expression of miR-1294 (OR, 1.32; 95%CI, 1.07-1.63) and miR-532-5p (OR, 1.57; 95%CI, 1.02-2.40) was associated with higher odds of restriction. Increased miR-451a expression was associated with lower odds of exertional dyspnea (OR, 0.71; 95%CI, 0.59-0.85). Twenty-two EV-miRNAs were associated with serum CC-16 levels (q< 0.05), suggesting that EV-miRNAs may play a role in the pathway linking CC-16 to COPD pathogenesis. A pathway analysis showed key EV-miRNAs targeted biological pathways that modulate inflammation, immunity, and structural integrity in the lungs. Circulating EV-miRNAs are novel mechanistic biomarkers of respiratory health and may facilitate the early detection and treatment of lung damage in American Indian populations that have been disproportionately affected by chronic lung diseases.

Psychometric Reliability, Validity, and Generalizability of MoCA in American Indian Adults: The Strong Heart Study.

Standardized neuropsychological instruments are used to evaluate cognitive impairment, but few have been psychometrically evaluated in American Indians. We collected Montreal Cognitive Assessment (MoCA) in 403 American Indians 70 to 95 years, as well as age, sex, education, bilingual status, depression symptoms, and other neuropsychological instruments. We evaluated inferences of psychometric validity, including scoring inference using confirmatory factor analysis and structural equation modeling, generalizability inference using reliability coefficient, and extrapolation inference by examining performance across different contexts and substrata. The unidimensional (total score) model had good fit criteria. Internal consistency reliability was high. MoCA scores were positively associated with crystallized cognition (ρ = 0.48, p < .001) and inversely with depression symptoms (ρ = -0.27, p < .001). Significant differences were found by education (d = 0.79, p < .05) depression (d = 0.484, p < .05), and adjudicated cognitive status (p = .0001) strata; however, MoCA was not sensitive or specific in discriminating cognitive impairment from normal cognition (area under the curve <0.5). MoCA scores had psychometric validity in older American Indians, but education and depression are important contextual features for score interpretability. Future research should evaluate cultural or community-specific adaptations, to improve test discriminability in this underserved population.

Suicidal ideation, suicide attempt, and self-injury among American Indian, Alaskan Native, and Native Hawaiian college students in the United States from 2015 to 2019.

Suicide is a major driver of mortality among college students and is the leading cause of death among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) young adults. Data on suicidal ideation, suicide attempt, and self-injury among AI/AN/NH college students (n = 8103) were analyzed via multivariable logistic regressions employing the American College Health Association National College Health Assessment survey from 2015 to 2019. Adjusted odds ratios (aORs) were used to assess how opioid misuse may act as a risk or protective factor for suicidality and self-injury. Between 2015 and 2019, suicidal ideation was the most prevalent dimension of suicidality affecting AI/AN/NH college students (ranges from 12.69% to 18.35%), followed by self-injury (7.83%-11.41%) and suicide attempt (2.40%-4.10%). AI/AN/NH college students who reported opioid misuse were significantly more likely to experience suicidal ideation (aOR: 1.417; 95% confidence interval [CI]: 1.154-1.740) and self-injury (aOR: 1.684; 95% CI: 1.341-2.116) than those who did not engage in such behavior. We identified opioid misuse as a potential risk factor for suicidal ideation and intentional self-injury among populations of AI/AN/NH college students. Programs seeking to reduce suicide prevalence among Indigenous college students may benefit from the inclusion of evidence-based interventions that prevent and treat issues related to opioid use.

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

A pilot study of virtual Harm Reduction Talking Circles for American Indian and Alaska Native adults with alcohol use disorder.

Prior research suggests that culturally aligned, accessible and lower-barrier interventions are well-placed to align with the needs of American Indian and Alaska Native (AI/AN) people with alcohol use disorder (AUD). Taking into account community members' suggestions and the need for physical distancing during the COVID-19 pandemic, our team developed a protocol for virtual Harm Reduction Talking Circles (HaRTC) to incorporate these points. The aims of this 8-week, single-arm pilot were to initially document feasibility, acceptability, and outcomes associated with attendance at virtual HaRTC, which integrates the accessibility of virtual connection, a lower-barrier harm-reduction approach, and a culturally aligned intervention. Participants (N = 51) were AI/AN people with AUD (current or in remission) across 41 Tribal affiliations and 25 US states. After a baseline interview, participants were invited to attend 8, weekly virtual HaRTC sessions. At the baseline, midpoint and post-test assessments, we collected data on virtual HaRTC acceptability, cultural connectedness, quality of life, and alcohol outcomes. Of the 123 people approached, 63% were interested in and consented to participation. Participants attended an average of 2.1 (SD = 2.02) virtual HaRTC sessions, with 64% of participants attending at least one. On a scale from 1 to 10, participants rated the virtual HaRTC as highly acceptable (M = 9.3, SD = 1.9), effective (M = 8.4, SD = 2.9), culturally aligned (M = 9.2, SD = 1.5), helpful (M = 8.8, SD = 1.9), and conducted in a good way (M = 9.8, SD = 0.5). Although the single-arm study design precludes causal inferences, participants evinced statistically significant decreases in days of alcohol use and alcohol-related harm over the three timepoints. Additionally, both sense of spirituality, which is a factor of cultural connectedness, and health-related quality of life increased over time as a function of the number of HaRTC sessions attended. Virtual HaRTC shows initial feasibility and acceptability as a culturally aligned intervention for AI/AN people with AUD. Future randomized controlled trials will provide a test of the efficacy of this approach.

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol

IntroductionSevere inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality,...

Provider perspectives on the impact of COVID-19 on treatment of substance use and opioid use disorders among American Indian and Alaska Native adults.

American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the opioid poisoning crisis, in combination with ongoing treatment barriers resulting from settler-colonialism, systemic oppression and racial discrimination. AI/AN adults are at greatest risk of COVID-19 related serious illness and death. In collaboration with an Indigenous community advisory board and Tribal leadership, this study explored AI/AN treatment provider perceptions of client-relatives' (i.e., SUD treatment recipients) experiences during the pandemic from 2020 to 2022. Providers who underwent screening and were eligible to participate (N = 25) represented 6 programs and organizations serving rural and urban areas in Washington, Utah, and Minnesota. Participants engaged in audio-recorded 60-90 min semi-structured individual interviews conducted virtually via Zoom. The interview guide included 15 questions covering regulatory changes, guidance for telemedicine, policy and procedures, staff communication, and client-relatives' reactions to implemented changes, service utilization, changes in treatment modality, and perceptions of impact on their roles and practice. Interview recordings were transcribed and de-identified. Members of the research team independently reviewed transcripts before reaching consensus. Coding was completed in Dedoose, followed by analyses informed by a qualitative descriptive approach. Five main domains were identified related to client-relative experiences during the COVID-19 pandemic, as observed by providers: (1) accessibility, (2) co-occurring mental health, (3) social determinants of health, (4) substance use, coping, and harm reduction strategies, and (5) community strengths. Providers reported the distinctive experiences of AI/AN communities, highlighting the impact on client-relatives, who faced challenges such as reduced income, heightened grief and loss, and elevated rates of substance use and opioid-related poisonings. Community and culturally informed programming promoting resilience and healing are outlined. Findings underscore the impact on SUD among AI/AN communities during the COVID-19 pandemic. Identifying treatment barriers and mental health impacts on client-relatives during a global pandemic can inform ongoing and future culturally responsive SUD prevention and treatment strategies. Elevating collective voice to strengthen Indigenous informed systems of care to address the gap in culturally-and community-based services, can bolster holistic approaches and long-term service needs to promote SUD prevention efforts beyond emergency response efforts.

Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020.

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic. From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening. Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9). The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

Reliability and Validity of Diabetes Nutrition Self-Efficacy and Behavior Measures for the “What Can I Eat” Diabetes Nutrition Education Program for American Indian and Alaska Native Adults With Type 2 Diabetes

BackgroundAmerican Indian and Alaska Native (AI/AN) people have high rates of diabetes and limited access to nutrition education. The “What Can I Eat? Healthy Choices for People With Type 2 Diabetes” (WCIE) diabetes nutrition education program was culturally adapted for AI/AN adults. ObjectiveThis analysis was designed to evaluate the reliability and validity of items developed to measure diabetes nutrition self-efficacy (ie, confidence one can engage in specific behaviors) and diabetes nutrition behavior among participants in the WCIE program for AI/AN adults. DesignThis study was a secondary analysis of data from a randomized controlled trial designed to evaluate the WCIE program for AI/AN adults. Baseline data were used to assess the reliability and validity of the self-efficacy and behavior items, which were collected via survey. Due to COVID-19 safety protocols, the intervention was conducted via Zoom (Zoom Video Communications), and both survey and clinical data were collected at home by participants. Participants/settingThe study was conducted from January to December 2021 with 5 AI/AN-serving health care programs in Oklahoma, Illinois, North Carolina, California, and New York. AI/AN adults with type 2 diabetes who spoke English and had internet access were eligible. Sixty people participated. Main outcome measuresAnalyses examined validity and reliability of diabetes nutrition self-efficacy and behavior items. Statistical analysis performedTo test reliability, internal consistency and factor structures of the scales were examined. To evaluate convergent validity, Pearson correlations were computed to examine the association of the self-efficacy and behavior measures with each other and with clinical indicators (ie, body mass index, blood pressure, and hemoglobin A1c). ResultsTwo self-efficacy factors were identified. Each showed strong internal consistency (Cronbach α ≥ 0.85; McDonald ω ≥ 0.88) and was directly associated with diabetes nutrition behavior (P < .001). The factor assessing Confidence in Using the Diabetes Plate was inversely associated with hemoglobin A1c (Pearson correlation = –0.32, P = .0243). The behavior measure capturing Healthy Nutrition Behavior showed strong internal consistency (α = 0.89; ω = 0.92) and was inversely associated with hemoglobin A1c (Pearson correlation = –0.38, P = .0057). ConclusionsDiabetes nutrition self-efficacy and behavior items developed for the WCIE program for AI/AN adults are valid and reliable. These items can facilitate rigorous and consistent evaluation of the AI/AN WCIE program.

Characterizing Cancer Burden in the American Indian Population in North Carolina.

The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality. We identified cancer cases diagnosed among adult AI and White populations between 2014 and 2018 from the North Carolina Central Cancer Registry. We estimated incidence and mortality rate ratios (IRR and MRR) by race. In addition, between the AI and White populations, we estimated the ratio of relative frequency differences [RRF, with 95% confidence limits (CL)] of clinical and sociodemographic characteristics. Finally, we evaluated the geographic distribution of incident diagnoses among AI populations. Our analytic sample included 2,161 AI and 204,613 White individuals with cancer. Compared with the White population, the AI population was more likely to live in rural areas (48% vs. 25%; RRF, 1.89; 95% CL, 1.81-1.97) and to have Medicaid (18% vs. 7%; RRF, 2.49; 95% CL, 2.27-2.71). Among the AI population, the highest age-standardized incidence rates were female breast, followed by prostate and lung and bronchus. Liver cancer incidence was significantly higher among the AI population than White population (IRR, 1.27; 95% CL, 1.01-1.59). AI patients had higher mortality rates for prostate (MRR, 1.72; CL, 1.09-2.70), stomach (MRR, 1.82; 95% CL, 1.15-2.86), and liver (MRR, 1.70; 95% CL, 1.25-2.33) cancers compared with White patients. To reduce prostate, stomach, and liver cancer disparities among AI populations in North Carolina, multi-modal interventions targeting risk factors and increasing screening and treatment are needed. This study identifies cancer disparities that can inform targeted interventions to improve outcomes among AI populations in North Carolina.

Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic

BackgroundFood insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people.MethodsIn partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences.ResultsAmong 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders.ConclusionsHigh rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.

Abstract 3944: Addressing stomach cancer disparities by assessing Helicobacter pylori infections among American Indian adults from the Navajo Nation

Abstract Background. The Navajo Nation, the largest tribe in the United States (US), is experiencing a high burden of stomach cancer, possibly due to a high prevalence of Helicobacter pylori (Hp) infection. Hp is a major risk factor for stomach cancer and Hp strains that carry the cagA-gene are linked to greater gastrointestinal disease severity. Yet little research has investigated the prevalence and correlates of Hp and cagA infection in Navajo people. We assessed the prevalence and correlates of Hp infection and cagA-gene carriage in adult tribal members residing in the Navajo Nation. Methods and Material. We conducted a community-based cross-sectional study in the Navajo Nation in 2021 during the COVID-19 pandemic. Participants were recruited using online and offline platforms, including social media, a study website, newspaper advertisements, flyers, word of mouth, and community outreach. Stool samples collected from participants were analyzed with droplet digital PCR for Hp 16S and cagA virulence genes. Demographic characteristics, health, and dietary factors were collected from self-administered health and food questionnaires sent via mail. Results. Of 99 participants, half (49.5%) were 18-44 years old and 73.7% were female. About sixty percent (57.7%, 95% CI: 47.6-67.3) of participants were infected with Hp, twice the US population prevalence (27%). Among Hp-infected participants, 76.7% (95% CI: 64.0-86.6) were cagA-gene positive, four times the cagA gene prevalence in White people (19%). Controlling for age and sex, monthly use of Navajo herbal medicines was positively associated with Hp infection (OR=3.73, 95% CI: 1.05-17.87). No significant associations with Hp and cagA-gene were observed with other risk factors such as older age, males, lower education, and high sodium intake. Conclusion. A substantial proportion of Navajo adults in our study had Hp and cagA-positive infections. Given studies showing the antibacterial activity of Indigenous herbal medicines, monthly use of Navajo herbal medicines was an unexpected risk factor for Hp infection. This observation may be due to reverse causality, where participants with gastrointestinal conditions used Navajo herbal medicines for gastrointestinal symptom relief, particularly when participants had limited access to healthcare services due to the COVID-19 pandemic. Possible environmental transmission of Hp in the preparation of herbal medicines (i.e., water source, utensils) could be another source of exposure. Given the high burden of Hp and cagA-positive infections, culturally tailored health education strategies and interventions addressing these infections present an opportunity for research and cancer prevention among Navajo adults. Citation Format: Dornell Pete, Nina R. Salama, Johanna W. Lampe, Michael C. Wu, Amanda I. Phipps. Addressing stomach cancer disparities by assessing Helicobacter pylori infections among American Indian adults from the Navajo Nation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3944.

Perceived discrimination, political efficacy, and political participation in American Indian adults

IntroductionPsychological factors linked to political participation are largely understudied in American Indians. Prior work notes relatively low levels of participation compared to other racial and ethnic groups and suggests that identification with being American Indian is linked to overall levels of civic engagement in part through perceptions of group discrimination.MethodsIn the current work, in a sample of 727 American Indian adults, we created two groups: Group 1 (N = 398) reported perceived discrimination related to race, and Group 2 (N = 329) reported perceived discrimination not related to race or ethnicity. We investigated the relationships between individual experiences of everyday discrimination related to race, levels of political efficacy, and political participation (Group 1), and individual experiences of everyday discrimination not related to race or ethnicity, political efficacy, and political participation (Group 2).ResultsWe found that greater experiences of everyday discrimination related to race was associated with higher levels of political participation through increased levels of internal and collective efficacy. In contrast, greater experiences of everyday discrimination related to race was associated with higher levels of political participation through lower external political efficacy. For Group 2, we found that greater experiences of everyday discrimination not related to race or ethnicity was not directly associated with political participation, but mediation analyses revealed a relationship with lower levels of political participation through decreased internal and collective efficacy. The indirect effect through external political efficacy was not significant.DiscussionGiven low levels of American Indian political participation, political efficacy could be a target for interventions aiming to increase participation in the political system.