Alaska Native People Research Articles

Relationship-Based Health Care: Achieving Improved Outcomes Through Shared Responsibility

Pressures are mounting on health care organizations today to provide better care while also controlling costs. Engaging people in their own health care can both result in better health outcomes for patients, and ease the burden on the medical system. Southcentral Foundation (SCF), an Alaska Native-owned health care system, transformed its system in the late 1990s to focus on customer-ownership and relationships. Today, SCF serves as an example of what can be achieved through a system focused on these core elements. 
 SCF does not refer to the people it serves as “patients.” This term sounds passive and does not reflect the level of engagement that SCF’s providers and customers have with each other and the customer’s health care. Rather, since the Alaska Native and American Indian people SCF serves are both customers and the owners of the health care system, they are referred to as “customer-owners.” This is not just a change in terminology, it signifies a change in the relationship between customer-owners and their care providers. Unlike a traditional system in which the patient often has a minimal role in their diagnosis and treatment, our customer-owners work together—in relationship—with their care providers to achieve overall wellness.
 These relationships are another central element of SCF’s whole system transformation. SCF recognizes that each individual has more control over his or her own health outcomes than providers, and that when providers build strong, long-term relationships with customer-owners, they can more effectively help customer-owners achieve wellness. Customer-owners choose their own providers and form strong, long-term relationships so providers can support them in their journeys toward wellness. 
 SCF’s focus on customer-ownership and relationships has resulted in improved health outcomes for customer-owners while also managing costs. Emergency Department visits for customer-owners decreased by 44%in the five years after SCF transformed its system, and inpatient discharges decreased by 63% over that same time period. SCF ranks above the 75th percentile for many health measures such as diabetes and cancer screenings. 97% of customer-owners are satisfied with the care provided by SCF, and SCF has also achieved 95% employee satisfaction.
 This workshop is for health care leaders, medical directors, improvement personnel, and anyone else looking for ideas for systemic reform. The session will be delivered in an interactive lecture format, with time allocated throughout for participants to discuss the material presented in small groups. After the discussions, the groups will report out to the larger group so that a variety of perspectives can be shared. Presenters will also regularly ask questions to engage the audience and encourage participants to share their own experiences and ideas relating to the material presented.
 At the end of the session, the key elements of SCF’s system of care will be summarized, along with points raised by participants during the session. Suggestions will also be offered for participants looking to reform their own systems according to principles of relationship-based care and customer-ownership.

INFLUENCES OF CULTURAL VALUES ON THE INDIGENOUS DEMENTIA CAREGIVERS’ EXPERIENCE

Abstract This symposium will outline and discuss the unique circumstances and challenges of American Indian, Alaska Native, and Native Hawaiians and Pacific Islander dementia caregivers. Dementia is one of the top causes of death worldwide, with Alzheimer’s disease currently being the ninth leading cause of death among American Indian and Alaska Native people (AI/AN). One in three American Indians and Alaska Natives over 65 will receive a dementia diagnosis in the next 25 years. Yet, we know very little about caregivers’ experiences in these communities. Presenters will present on how cultural influences shape caregiver’s experiences within American and Alaska Native, Native Hawaiians and Pacific Islanders. The second presenter will discuss the need for culturally safe dementia caregiver resources based on recommendations from Alaska Native caregivers. The third presenter will examine decision-making processes of dementia caregiver involved in the use of governmental and tribal dementia care resources within the ONEIDA Nation to improve utilization of existing services.

ALASKA NATIVE DEMENTIA CAREGIVERS AND THE INCREASING NEED FOR CULTURALLY SAFE RESOURCES

Abstract With the rate of dementia increasing among Alaska Native people and the tribal health system ill-equipped to meet the challenges associated with dementia care, there is an urgent need to better understand cultural perspectives on dementia caregiving and what states and communities can do to support their caregivers. Despite the fact caring for others is a value and cultural practice for Indigenous communities, and caregivers tend to report fewer challenges and barriers related to care, they still experience barriers and challenges. Guided by Kleinman’s explanatory model of illness, a qualitative, the aim of this study was to gain insight on Alaska Native caregiver experiences in caring for someone living with dementia in communities across Alaska. 21 interviews with Alaska Native dementia caregivers in rural and urban communities were completed. Despite being innovative and resourceful in providing care, caregivers reported the high cost of care, inadequate training of health care providers, and the paucity of culturally safe caregiver training, education, and resources are especially concerning and need to be addressed in a timely fashion. Caregivers in this study recommended the development of basic educational materials to be aware of dementia, its stages, and the available supports, as well as caregiver support and respite services. The recommendations from this study focus on outreach and education for caregivers to improve their access to education, training, and support to reduce isolation, increase their dementia knowledge, expand their awareness of ancillary resources, and inform help-seeking decisions.

Longitudinal associations of depression and diabetes with Alzheimer’s disease and related dementias risk among American Indian and Alaska Native people

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) research worldwide indicate that it is more common in indigenous than in non‐indigenous populations. The increased risk for ADRD among indigenous people may be partially due to the population’s high rates of depression and diabetes. Thus, we examined the relationship of depression and diabetes, alone and together, with incident ADRD in a large sample of American Indian and Alaska Native people (AI/ANs).MethodWe used data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project with a sample of 65,801 AI/ANs aged ≥ 45 years. The IHS Data Project includes data for a purposeful sample of AI/ANs who lived in 15 IHS service units, which are IHS geographic classifications located throughout the United States. We used Cox proportional hazard models to estimate associations between ADRD risk and baseline depression and diabetes.ResultWe found that 2.3% of our sample received an ADRD diagnosis during FY2010‐13. Compared to persons with neither depression nor diabetes, unadjusted models indicated that those who had both depression and diabetes had twice the risk of developing ADRD (Hazard Ratio (HR) = 2.02, 95% CI = 1.72‐2.37). The unadjusted risk among those with depression only was 77% higher (HR = 1.77, 95% CI = 1.50‐2.08). Adjusted analyses showed that the HR for those with depression and diabetes was 1.82 (95% CI = 1.53‐2.16) and those with depression only had a hazard ratio of 1.70 (95% CI = 1.44‐2.00) for ADRD. The association between depression and diabetes and depression only with ADRD risk was stronger for persons aged 45 to 64 years compared to persons aged ≥ 65 years. In the adjusted models, we did not find a relationship between only having diabetes and ADRD risk.ConclusionOur findings suggest that depression by itself and depression with diabetes increases the risk of ADRD in AI/ANs aged ≥ 45 years. In the future, ensuring clinical and behavioral services for AI/ANs include regular mental health screening and depression treatment might help decrease ADRD risk. Such efforts may also focus on middle‐aged persons.

Genetic research with Indigenous Peoples: perspectives on governance and oversight in the US

IntroductionIndigenous Peoples are increasingly exerting governance and oversight over genomic research with citizens of their nations, raising questions about how best to enforce research regulation between American Indian, Alaska Native, and Native Hawaiian peoples and researchers.MethodsUsing a community-engaged research approach, we conducted 42 semi-structured interviews with Tribal leaders, clinicians, researchers, policy makers, and Tribal research review board members about their perspectives on ethical issues related to genetics research with Indigenous Peoples in the US.ResultsWe report findings related to (1) considerations for Indigenous governance, (2) institutional relationships upholding sovereignty, (3) expectations for research approvals, and (4) agreements enacting Indigenous governance. Participants described concerns about different ways of exerting oversight, relationships and agreements between Indigenous Peoples and researchers, and gaps that need to be addressed to strengthen existing governance of genomic data.DiscussionThe results will ultimately guide policy-making and development of new strategies for Indigenous Peoples to enforce oversight in research to promote ethically and culturally appropriate research.

Experiences of Alaska Native people living with burn injury and opportunities for health system strengthening

BackgroundInjuries are a leading cause of death and disability for Alaska Native (AN) people. Alaska Native Tribal Health Consortium (ANTHC) is supporting the development of a burn care system that includes a partnership between Alaska Native Medical Center (ANMC) in Anchorage, AK and UW Medicine Regional Burn Center at Harborview Medical Center (HMC) in Seattle, WA. We aimed to better understand the experiences of AN people with burn injuries across the care continuum to aid development of culturally appropriate care regionalization.MethodsWe performed focus groups with twelve AN people with burn injury and their caregivers. A multidisciplinary team of burn care providers, qualitative research experts, AN care coordinator, and AN cultural liaison led focus groups to elicit experiences across the burn care continuum. Transcripts were analyzed using a phenomenological approach and inductive coding to understand how AN people and families navigated the medical and community systems for burn care and areas for improvement.ResultsThree themes were identified: 1-Challenges with local burn care in remote communities including limited first aid, triage, pain management, and wound care, as well as long-distance transport to definitive care; 2-Divergence between cultural values and medical practices that generated mistrust in the medical system, isolation from their support systems, and recovery goals that were not aligned with their needs; 3-Difficulty accessing emotional health support and a survivor community that could empower their resilience.ConclusionParticipants reported modifiable barriers to culturally competent treatment for burn injuries among AN people. The findings can inform initiatives that leverage existing resources, including expansion of the Extension for Community Healthcare Outcomes (ECHO) telementoring program, promulgation of the Phoenix Society Survivors Offering Assistance in Recovery (SOAR) to AK, coordination of regionalized care to reduce time away from AK and provide more comfortable community reintegration, and define rehabilitation goals in terms that align with personal goals and subsistence lifestyle skills. Long-distance transport times are non-modifiable, but better pre-hospital care could be achieved by harnessing existing telehealth services and adapting principles of prolonged field care to allow for triage, initial care, and resuscitation in remote environments.

Prevalence of Diagnosed Type 1 and Type 2 Diabetes Among American Indian and Alaska Native Peoples in 2012-2013.

Prevalence of Diagnosed Type 1 and Type 2 Diabetes Among American Indian and Alaska Native Peoples in 2012-2013.

Community-Level Factors are Predictors of Severe Maternal Morbidity Among American Indian and Alaska Native Pregnant People in the Pacific Northwest in a Multilevel Logistic Regression.

American Indian/Alaska Native (AI/AN) pregnant people face barriers to health and healthcare that put them at risk of pregnancy complications. Rates of severe maternal morbidity (SMM) among Indigenous pregnant people are estimated to be twice that of non-Hispanic White (NHW) pregnant people. Race-corrected Oregon Hospital Discharge and Washington Comprehensive Hospital Abstract Reporting System data were combined to create a joint dataset of births between 2012 and 2016. The analytic sample was composed of 12,535 AI/AN records and 313,046 NHW records. A multilevel logistic regression was used to assess the relationship between community-level, individual and pregnancy risk factors on SMM for AI/AN pregnant people. At the community level, AI/AN pregnant people were more likely than NHW to live in mostly or completely rural counties with low median household income and high uninsured rates. They were more likely to use Medicaid, be in a high-risk age category, and have diabetes or obesity. During pregnancy, AI/AN pregnant people were more likely to have insufficient prenatal care (PNC), gestational diabetes, and pre-eclampsia. In the multilevel model, county accounted for 6% of model variance. Hypertension pre-eclampsia, and county rurality were significant predictors of SMM among AI/AN pregnant people. High-risk age, insufficient PNC and a low county insured rate were near-significant at p < 0.10. Community-level factors are significant contributors to SMM risk for AI/AN pregnant people in addition to hypertension and pre-eclampsia. These findings demonstrate the need for targeted support in pregnancy to AI/AN pregnant people, particularly those who live in rural and underserved communities.

Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.

The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.

Dermatology Access and Needs of American Indian and Alaska Native People

Abstract: Objectives. To describe skin disease prevalence, access to dermatologic care, and teledermatology interest among American Indians and Alaska Natives. Methods. Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022. Results. Most American Indian and/or Alaska Native respondents (94.5%, n=225) reported at least one skin disease. The top three active skin diseases among adolescents were acne, scarring, and eczema. The top three among adults were dry skin, hair loss, and acne. Only 20.9% (n=47) of respondents with skin disease had seen a dermatologist. Approximately one-third of respondents (34.0%, n=81) were open to engaging with teledermatology in their home; 43.3% (n=103) were open to engaging with teledermatology in their local clinic; 42.0% (n=100) were not interested in engaging teledermatology from their home or in their local clinic. Conclusions. Skin disease is prevalent and access to dermatologic care is poor among American Indian and Alaska Native people.

Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study

Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. How do American Indian and Alaska Native adults perceive and use lung cancer screening? We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. Participants (n= 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.

Experiences With and Access to Evidence-Based Health Promotion Programs for Older American Indian, Alaska Native, and Native Hawaiian Peoples.

Evidence-based programs (EBPs) work effectively for participants whose characteristics match those of the EBP research participants. However, EBPs have been almost exclusively developed and evaluated for the general U.S. population with limited American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) community engagement. Thus, an AI/AN/NH Evidence-Based Program Advisory Council sought to identify AI/AN/NH peoples' experiences with and access to EBPs. We held 20 listening sessions with AI/AN/NH Elder services program staff (n = 118) and with AI/AN/NH Elders (n = 82) and conducted a self-administered online survey with Title VI Directors (n = 63). The six themes that emerged from the listening sessions with staff included misunderstanding community engagement, valuing fidelity over flexibility, lack of cultural awareness, assumptions about available infrastructure, unrealistic implementation timelines, and funding restrictions. Listening session themes with Elders included definitions of aging well, participation motivators, preferred activities, participation barriers, and unmet needs. Survey data indicated that programming of greatest interest for Elders as identified by Title VI Directors and staff included and/or addressed cultural activities (81%), socialization (75%), diabetes (73%), caregiving (68%), and nutrition (68%). Seventy-six percent of survey respondents had heard of EBPs and 24% indicated that EBPs were not being implemented in their community. The Advisory Council developed specific action steps with the goal of improving AI/AN/NH communities' access to culturally appropriate and feasible EBPs. The steps require collective action from federal agencies, national partners, EBP program developers and administrators, local organizations, and Elders to ensure EBPs are accessible and culturally appropriate for AI/AN/NH Elders.

Association between gene methylation and experiences of historical trauma in Alaska Native peoples

BackgroundHistorical trauma experienced by Indigenous peoples of North America is correlated with health disparities and is hypothesized to be associated with DNA methylation. Massive group traumas such as genocide, loss of land and foodways, and forced conversion to Western lifeways may be embodied and affect individuals, families, communities, cultures, and health. This study approaches research with Alaska Native people using a community-engaged approach designed to create mutually-beneficial partnerships, including intentional relationship development, capacity building, and sample and data care.MethodsA total of 117 Alaska Native individuals from two regions of Alaska joined the research study. Participants completed surveys on cultural identification, historical trauma (historical loss scale and historical loss associated symptoms scale), and general wellbeing. Participants provided a blood sample which was used to assess DNA methylation with the Illumina Infinium MethylationEPIC array.ResultsWe report an association between historical loss associated symptoms and DNA methylation at five CpG sites, evidencing the embodiment of historical trauma. We further report an association between cultural identification and general wellbeing, complementing evidence from oral narratives and additional studies that multiple aspects of cultural connection may buffer the effects of and/or aid in the healing process from historical trauma.ConclusionA community-engaged approach emphasizes balanced partnerships between communities and researchers. Here, this approach helps better understand embodiment of historical trauma in Alaska Native peoples. This analysis reveals links between the historical trauma response and DNA methylation. Indigenous communities have been stigmatized for public health issues instead caused by systemic inequalities, social disparities, and discrimination, and we argue that the social determinants of health model in Alaska Native peoples must include the vast impact of historical trauma and ongoing colonial violence.

The use of patient navigation to transition detoxification patients to substance use treatment in the Alaska Interior

ObjectivesDetoxification clinics manage acute intoxication and withdrawal from alcohol and other drugs. At discharge, patients are referred to treatment, yet many are readmitted to detoxification, creating a “revolving door” of discharges and admissions. This pattern disproportionately affects some groups such as Alaska Native and American Indian (AN/AI) people. The primary goals of this study are to: 1) test the effectiveness of a patient navigation intervention to increase rates of transition to alcohol treatment following detoxification, and 2) prevent readmission to detoxification within 12-months. The secondary goal is a cost-effectiveness and cost-benefit evaluation of patient navigation. Study designThis randomized controlled comparative effectiveness trial plans to recruit 440 patients (∼70% AN/AI) admitted to alcohol detoxification. We collaborated with Fairbanks Native Association (FNA) to select an appropriate intervention, control condition, and other study-related decisions. Here, we describe intervention development, study design, challenges encountered during implementation, and collaborative processes to identify solutions. MethodsParticipants are equally randomized to the control (one motivational interviewing session) or intervention (one motivational interviewing session plus up to four weeks of patient navigation). The primary outcomes are successful transition to alcohol treatment within 30-days after discharge and detoxification readmission within 12-months. The secondary outcome is health-related quality of life. ConclusionPatient navigation is successful in other settings and for other health conditions. It may assist in overcoming barriers to successful transition to substance use treatment and may augment interventions, such as motivational interviewing, that are less resource-intensive but may not be optimally effective by themselves. ClinicalTrials.gov IdentifierNCT03737864.

Assessing the Feasibility, Acceptability, and Effectiveness of a Pilot Hepatitis C Screening Program at Food Distribution Sites in Cherokee Nation, Oklahoma

Compared with other racial and ethnic groups in the United States, American Indian and Alaska Native (AI/AN) people experience the highest incidence of acute hepatitis c (HCV). Cherokee Nation Health Services (CNHS) implemented a pilot health screening program from January through May 2019 to assess whether conducting HCV and other preventive health screenings at food distribution sites is a feasible, acceptable, and effective strategy to increase health screening among underserved community members. Data were collected among 340 eligible participants. Most (76%) participants reported being very comfortable receiving health screenings at food distribution sites and that getting screened at food distribution sites is very easy (75.4%). Most (92.1%, n = 313) participants received HCV screening, with 11 (3.5%) individuals testing positive for HCV antibodies. Of the 11 HCV seropositive individuals, six were confirmed to have active HCV infection of which four initiated treatment. Most (55.7%) participants exhibited a body mass index in the obese range, 33.1% exhibited high hemoglobin A1C (> 6.0), 24.5% exhibited high (> 200) cholesterol, 44.6% exhibited high blood pressure ( > = 140/90), and 54.8% did not have a current primary care provider. This project demonstrated that conducting HCV and other health screenings at food distribution sites within Cherokee Nation was an effective strategy to engage AI/AN people in preventive health screenings. Future programs are needed to scale-up preventive health screenings outside of traditional medical facilities as these types of screenings may help to decrease the HCV disparities among AI/AN people.

Autoimmune hepatitis and overlap syndrome among Alaska Native people: Prevalence, clinical characteristics, and remission.

High autoimmune hepatitis (AIH) and overlap syndrome (OS) prevalence have been previously documented among Alaska Native people. The purpose of this project is to report changes in AIH/OS prevalence over time, clinical characteristics, and factors associated with biochemical remission. We reviewed medical records for Alaska Native/American Indian (AN/AI) patients diagnosed with AIH/OS between 1984 and 2021. Point prevalence was calculated based on AIH/OS patients alive at the end of 2021 and at 5-year intervals from July 1, 2000, to July 1, 2020. We identified 189 AN/AI persons diagnosed with AIH or OS (157 AIH, 32 OS). Of these 189, 137 were alive at the end of 2021 for a point prevalence of 91.2 per 100 000 (95% confidence interval [CI]: 77.2-107.8)-75.9 (95% CI: 63.2-91.2) for AIH and 15.3 (95% CI: 10.2-23.0) for OS. Prevalence for both AIH and OS has risen steadily since 2000. Eighty-nine consented participants (62.7%) achieved biochemical remission with a median time from diagnosis to start of remission of 1.9 years (IQR 0.5-5.0 years). Consented patients with fatty liver were less likely to achieve remission, but their time to remission was shorter than for patients without fatty liver. The AN/AI population in Alaska continues to have the highest reported prevalence of AIH/OS in the world, with prevalence rising steadily since 2000. High reported AIH/OS prevalence is likely due in part to strong referral networks for liver disease. Detection and treatment can lead to biochemical remission and improved health outcomes.

Social Media Use among American Indian and Alaska Native People: Implications for Health Communication Strategies.

Patients, health professionals, and communities use social media to communicate information about health determinants and associated risk factors. Studies have highlighted the potential for social media to reach underserved populations, suggesting these platforms can be used to disseminate health information tailored for diverse and hard-to-reach populations. Little is known, however, about the use of social media among American Indian and Alaska Native populations. The objective of this cross-sectional study is to better understand the use of social media platforms to disseminate information across these populations. Our team surveyed 429 American Indian and Alaska Native adults attending cultural events in Washington State on their use of various types of social media. We used logistic regressions to assess participant use of Twitter, Snapchat, Facebook, and Instagram as related to participant demographics, including age, gender, education, and their place of residence (on-reservation, rural off-reservation areas, or large metropolitan areas). Findings showed that Facebook was used by more participants than other platforms (79%), followed by Instagram (31%). Nearly half of participants used only one social media platform (48%). Age was negatively associated with using Instagram (0.8 OR, 95% CI: 0.7, 0.9) and Snapchat (0.6 OR, 95% CI: 0.5, 0.7). College education was associated with higher odds of using an additional social media platform compared to those without any college education (2.0 OR, 95% CI: 1.1, 3.6). Most participants used social media platforms, which suggests these platforms may be a useful tool in disseminating information to American Indian and Alaska Native peoples. Further research should document how social media can be used to effectively disseminate risk and health information and assess whether it can influence health knowledge and behaviors among these populations.

COVID-19 pandemic effects on emotional health and substance use among urban American Indian and Alaska Native people

ObjectiveThe COVID-19 pandemic has disproportionately affected American Indian and Alaska Native (AI/AN) people, who experience a 3.2 times higher age-adjusted rate of hospitalization and nearly double the attributed deaths compared to non-Hispanic Whites. We examined pandemic effects on emotional health and substance use in urban AI/AN people. MethodsFrom January–May 2021 we collected cross-sectional data from 642 patients seen at five health organizations serving primarily AI/AN people in urban settings. The outcomes are self-reported, cross-sectional changes in emotional health and substance use since pandemic onset. Exposures of interest include infection history, COVID-19 risk perception, pandemic-related life disruption, and feared effects on AI/AN culture. Poisson regression was used to model adjusted multivariate associations. ResultsSince pandemic onset, 46% of participants reported worsened emotional health; 20% reported increased substance use. Very or extremely disruptive pandemic experiences and increasing reported feared pandemic effects on culture were associated with worse pandemic emotional health [adjusted Prevalence Ratio 1.84; 95% CI 1.44, 2.35 and 1.11; 95% CI 1.03, 1.19], respectively. COVID-19 infection and risk perception were not associated with emotional health after adjustment for other factors. The primary exposures were not associated with change in substance use. ConclusionsThe COVID-19 pandemic has impacted the emotional health of urban AI/AN people. The finding that poor emotional health is associated with pandemic-related threats to AI/AN culture may signal a protective role for community and cultural resources. This warrants further study as exploratory analysis did not find hypothesized effect modification according to strength of affiliation with AI/AN culture.

Comparison of HBV DNA and RNA markers in Alaska Native people who did and did not clear hepatitis B surface antigen.

In a comparison between 50 Alaska Native persons with chronic hepatitis B who cleared HBV surface antigen (HBsAg) and 50 Alaska Native age-, sex-, and HBV genotype-matched controls, we found differences in changes in HBV DNA and HBV RNA levels over time but no difference in hepatitis B core-related antigen. These findings suggest that serial HBV DNA and HBV RNA may be associated with HBV functional cure defined by HBsAg clearance.

Antiracism in Action: Development and Outcomes of a Mentorship Program for Premedical Students Who Are Underrepresented or Historically Excluded in Medicine.

Black, Latinx, and Native American and Alaska Native people are underrepresented in medicine. The increasingly competitive medical school application process poses challenges for students who are underrepresented in medicine or historically excluded from medicine (UIM/HEM). The University of California, San Francisco-University of California, Berkeley (UCSF-UCB) White Coats for Black Lives Mentorship Program provides a novel and antiracist approach to mentorship for these premedical students. The program recruited UIM/HEM premedical and medical students through a survey advertised by email, on the program's website, social media, and by word of mouth. The program paired students primarily with race-concordant mentors, all of whom were UCSF medical students. From October 2020 to June 2021, program mentees engaged in skills-building seminars based on an antiracism framework and received support for preparing medical school applications. The program administered preprogram and postprogram surveys to mentees, which were analyzed via quantitative and qualitative methods. Sixty-five premedical mentees and 56 medical student mentors participated in the program. The preprogram survey received 60 responses (92.3% response rate), and the postprogram survey received 48 responses (73.8% response rate). In the preprogram survey, 85.0% of mentees indicated that MCAT scores served as a barrier "a great deal" or "a lot," 80.0% indicated lack of faculty mentorship, and 76.7% indicated financial considerations. Factors that improved most from preprogram to postprogram were personal statement writing (33.8 percentage-point improvement, P < .001), peer mentorship (24.2 percentage-point improvement, P = .01), and knowledge of medical school application timeline (23.3% percentage-point improvement, P = .01). The mentorship program improved student confidence in various factors influencing the preparation of medical school applications and offered access to skills-building resources that mitigated existing structural barriers.