Alaska Research Articles

Evolving Trends in US Mortality from Opioid Overdose: Heroin and Beyond

ObjectiveOur objective was to explore evolving trends in US drug overdose mortality, overall and by age, sex, race, urbanization, and geography from 1999-2020. MethodsThis is a descriptive epidemiologic study. We used the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research and Multiple Cause of Death files from the National Center for Health Statistics. We used crude and age-adjusted cause of death and mortality rate ratios as measures of effects and 95% confidence limits to test for significance. ResultsFrom 1999-2020, drug overdoses caused 1,013,852 deaths and 4.3-fold increase in mortality rate ratios. Subgroup findings were sex (4.5 men, 4.0 women), race (4.6 White, 3.9 Black or African American, 4.0 Asian or Pacific Islanders, 5.1 Native Americans or Alaskan Natives), age (highest 5.6 in 25-34 years, lowest 1.1 in 75-84, and 0.77 in 85+), geography (highest 6.0 in Midwest, lowest 2.6 in West), and urbanization (highest 6.2 in non-metro, lowest 3.7 in metro). ConclusionsDrug overdoses in the United States from 1999-2020 increased 4.3-fold, with the highest increase in White and Native American or Alaskan Native populations, and Midwest and non-metro areas. The data create preventive and therapeutic challenges, including restrictions on pharmaceutical industries and enhanced efforts by health care providers in safer prescribing. Addiction care should be integrated into all clinical practices, regardless of specialty, and into undergraduate, graduate, and continuing medical education. Targeted interventions are needed to adequately assess patients and provide care. Analytic studies designed a priori are necessary to test hypotheses formulated from these data.

The effect of adverse childhood experiences on family mealtime frequency: Examining racial and ethnic differences.

Eating meals as a family is associated with multiple positive nutritional and emotional outcomes for parents and children. Although the benefits of mealtimes extend to all families, families of color and those in poverty face disproportional barriers to eating frequent meals together. No previous study has properly attended to the heterogeneity of racial and ethnic groups in the United States when assessing mealtime barriers. Focusing on adverse childhood experiences (ACEs), our analyses tested whether an increased number of adversities, and particular types of adversities, were associated with a decrease in mealtime frequency for different racial/ethnic families in the United States. Utilizing a large, nationally representative sample of families (n = 59,963), results showed that higher cumulative ACE scores reduced the number of days a family eats meals together in a given week. For specific ACE items, seven out of nine individual ACE items were associated with decreased mealtimes (excluding parental death and racial discrimination). Stratification resulted in varied associations between accumulated and individual ACE items and mealtime frequency depending on racial/ethnic group. Asian families in particular had greater odds of infrequent meals than other families, while Native American, Alaskan Native, Pacific Islander, and other racial/ethnic families were unaffected by increased ACEs. Results indicate that a family's accumulation of multiple adversities may impede mealtimes by either forcing families to prioritize the management of other stressors or by depleting the physical and mental resources needed to establish a routine. Focusing on family cultural traditions as protective factors may be an area of future intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Acute Toxicity of Copper to Three Species of Pacific Salmon Fry in Water with Low Hardness and Low Dissolved Organic Carbon.

Proposed development of a mine within Alaska's Bristol Bay watershed (USA) has raised concerns about the potential impact of copper (Cu) on Pacific salmon (Oncorhynchus spp.). We conducted 96-h flow-through bioassays using low-hardness and low dissolved organic carbon water to determine the acute lethal toxicity of Cu to sockeye (Oncorhynchus nerka), Chinook (Oncorhynchus tshawytscha), and coho salmon (Oncorhynchus kisutch) fry. We aimed to determine Cu toxicity under field-relevant water quality conditions and to assess three methods of calculating ambient Cu criteria: the biotic ligand model (BLM), a multiple linear regression model endorsed by the US Environmental Protection Agency, and the hardness-based model currently used by the State of Alaska. The criteria generated by all models were below 20% lethal Cu concentrations by factors ranging from 2.2 to 54.3, indicating that all criteria would be protective against mortality. The multiple linear regression-based criteria were the most conservative and were comparable to BLM-based criteria. The median lethal concentrations (LC50s) for sockeye, Chinook, and coho were 35.2, 23.9, and 6.3 µg Cu/L, respectively. We also used the BLM to predict LC50s for each species. Model predictions differed from empirical LC50s by factors of 0.7 for sockeye and Chinook salmon, and 1.1 for coho salmon. These differences fell within the acceptable range of ±2, indicating the model's accuracy. We calculated critical lethal Cu accumulation values for each species to account for differing water chemistry in each bioassay; the present study revealed that coho salmon were most sensitive to Cu, followed by sockeye and Chinook salmon. Our findings underscore the importance of considering site- and species-specific factors when modeling Cu toxicity. The empirical data we present may enhance Cu risk assessments for Pacific salmon. Environ Toxicol Chem 2023;42:2440-2452. © 2023 SETAC.

Regional variation in HPV Knowledge and Awareness among American Indians and Alaska Natives: an analysis of the Health Information National Trends Survey, 2011-2020.

American Indian and Alaskan Native (AIAN) people experience a disproportionately high incidence of HPV-related cancers and mortality, and these rates vary across geographic regions. To address the unexplained regional differences among AIAN people, we describe regional variations and socio-demographic correlates of HPV-related knowledge and HPV vaccination awareness indicators. A cross-sectional study was implemented with data for 866 AIAN respondents pooled from eight cycles of the Health Information National Trends Survey (HINTS). We used chi-square tests to determine if there were regional differences in the indicators and then used multivariable, modified Poisson regression to explore associations between socio-demographic characteristics and HPV-related knowledge and vaccination awareness measures. Of the 13 indicators, just one demonstrated regional variation. However, we observed a high level of uncertainty regarding HPV and HPV-vaccine-related knowledge and experience. We also observed that women were more likely than men to have heard of HPV (aPR 1.29, 95%CI:1.03-1.63), the HPV vaccine (aPR 1.59, 95%CI: 1.15-2.22), and to have discussed it with their providers (aPR 3.69, 95%CI: 1.47-9.28). There were also differences by age, education, and insurance status. High levels of uncertainty and lack of regional variation in indicators suggest that there may be missed opportunities across Indian Country for engagement between healthcare providers and AIAN in HPV-related conversations. Efforts towards improving HPV knowledge and vaccination should target all at-risk sexes (and genders), age groups, and education levels. Moreover, AIAN-serving healthcare providers should be empowered with sufficient understanding, so they are prepared for discussions with at-risk patients.

Retrospective Cohort Analysis of Sex Differences in American Indians and Alaska Natives With Invasive Melanoma From the National Cancer Database.

Retrospective Cohort Analysis of Sex Differences in American Indians and Alaska Natives With Invasive Melanoma From the National Cancer Database.

Physiologic hormone administration improves HbA1C in Native Americans with type 2 diabetes: A retrospective study and review of insulin secretion and action.

Insulin is secreted in pulses from pancreatic beta-cells, and these oscillations maintain fasting plasma glucose levels within a narrow normal range. Within islets, beta-cells exhibit tight synchronization of regular oscillations. This control circuit is disrupted in type 2 diabetes, and irregularities in pulse frequency and amplitude occur. The prevalence of type 2 diabetes is three times higher in American Indian and Native Alaskans compared to Whites, and their genetic ancestry is associated with low beta-cell function. Obesity in this population compounds their vulnerability to adverse outcomes. The purpose of this article is to review insulin secretion and action and its interaction with race. We also present the results from a 6-month retrospective chart review of metabolic outcomes following intravenous physiologic hormone administration to 10 Native Americans. We found reductions in hemoglobin A1C (baseline: 9.03% ± 2.08%, 6months: 7.03% ± 0.73%, p = 0.008), fasting glucose (baseline: 176.0 ± 42.85 mg/dL, 6months: 137.11 ± 17.05 mg/dL, p = 0.02), homeostatic model assessment of insulin resistance (baseline: 10.39 ± 4.66, 6months: 7.74 ± 4.22, p = 0.008), and triglycerides (baseline: 212.20 ± 101.44, 6months: 165.50 ± 76.48 mg/dL, p = 0.02). Physiologic hormone administration may improve components of the metabolic syndrome. The therapy warrants investigation in randomized controlled trials.

Program Evaluation of a Community-Engaged Partnership Between a Counselor Preparation Program and Adult Probation Services

This study evaluated counseling services provided by counselor trainees to individuals on probation within a partnership between a counselor training program and a community supervision department. Eighty-one participants were included in the program evaluation, with 65 reporting demographics. Participants ranged in age from 18 to 74 and included 35 men and 30 women. Of those 65, 67.7% identified as White, 24.6% as African American, 6.2% as another race not specified, and 1.5% Native American or Alaskan Native. Additionally, 83.1% identified as non-Hispanic and 16.9% as Hispanic. Pre–post assessments were completed and Wilcoxon signed-rank tests revealed statistically significant reduction of anxiety, depression, posttraumatic stress symptoms, anger reactions, and relapse symptoms, and a statistically significant increase in presence of meaning in life, self-efficacy, and life satisfaction. Percentage improvement revealed more than half of the participants had clinically significant improvement in depression, anxiety, and posttraumatic stress disorder symptoms. Results indicate promise for community-engaged partnerships to provide no-cost responsive counseling services to individuals on probation.

Factors Associated with Vaccine Hesitancy in the State of Alaska.

Vaccine hesitancy (VH) is a major public health problem which includes not only concerns about vaccine, but often includes beliefs not aligned with evidence. The etiology of VH is complicate, including genuine concerns about vaccine safety to beliefs in disproven or unsubstantiated theories. Understanding VH includes determining the factors associated with people most likely to be susceptible. To identify characteristics of persons more likely to have VH based on perceived vaccine safety. We conducted a cross sectional, targeted online survey of 1,024 respondents. The survey collected data on demographics and vaccine beliefs. A seven-question VH scale was created based on an extensive literature review. When measured, this scale had high internal validity based on Cronbach's Alpha (α = 0.80, 95% CI, 0.79, 0.82) and provided a continuous measurement to understand the VH degree. Persons reporting a conservative political ideology had the highest VH score ([Formula: see text] = 15.0), followed by other ([Formula: see text] =12.7), moderate ([Formula: see text] =9.29), and liberal ([Formula: see text] =6.72). Education level was another strong indicator of VH, decreasing from the highest score of high school graduates ( [Formula: see text] = 13.2) to graduate degree holders ([Formula: see text] = 9.22). The more conservative a person's political ideology, the higher the VHS. We asked for ideology, rather than political party, although they are related, they are not the same. Ideology influences more domains than voting patterns. Higher educational attainment shows a protective effect against VH. These findings have direct implication for public health interventions, new interventions should be designed to be more accessible for persons with less formal education and more amenable to persons who hold a more conservative ideology.

Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

BackgroundAmerican Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented.MethodsWe conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews.ResultsFour key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals.ConclusionFindings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.

Comparing Sediment Microbial Communities of Arctic Beaver Ponds to Tundra Lakes and Streams

AbstractIn recent decades the habitat of North American beaver (Castor canadensis) has expanded from boreal forests into Arctic tundra ecosystems. Beaver ponds in Arctic watersheds are known to alter stream biogeochemistry, which is likely coupled with changes in the activity and composition of microbial communities inhabiting beaver pond sediments. We investigated bacterial, archaeal, and fungal communities in beaver pond sediments along tundra streams in northwestern Alaska (AK), USA and compared them to those of tundra lakes and streams in north‐central Alaska that are unimpacted by beavers. β‐glucosidase activity assays indicated higher cellulose degradation potential in beaver ponds than in unimpacted streams and lakes within a watershed absent of beavers. Beta diversity analyses showed that dominant lineages of bacteria and archaea in beaver ponds differed from those in tundra lakes and streams, but dominant fungal lineages did not differ between these sample types. Beaver pond sediments displayed lower relative abundances of Crenarchaeota and Euryarchaeota archaea and of bacteria from typically anaerobic taxonomic groups, suggesting differences in rates of fermentative organic matter (OM) breakdown, syntrophy, and methane generation. Beaver ponds also displayed low relative abundances of Chytridiomycota (putative non‐symbiotic) fungi and high relative abundances of ectomycorrhizal (plant symbionts) Basidiomycota fungi, suggesting differences in the occurrence of plant and fungi mutualistic interactions. Beaver ponds also featured microbes with taxonomic identities typically associated with the cycling of nitrogen and sulfur compounds in higher relative abundances than tundra lakes and streams. These findings help clarify the microbiological implications of beavers expanding into high latitude regions.

Simulating spatio-temporal dynamics of surface PM2.5 emitted from Alaskan wildfires

Wildfire is a major disturbance agent in Arctic boreal and tundra ecosystems that emits large quantities of atmospheric pollutants, including PM2.5. Under the substantial Arctic warming which is two to three times of global average, wildfire regimes in the high northern latitude regions are expected to intensify. This imposes a considerable threat to the health of the people residing in the Arctic regions. Alaska, as the northernmost state of the US, has a sizable rural population whose access to healthcare is greatly limited by a lack of transportation and telecommunication infrastructure and low accessibility. Unfortunately, there are only a few air quality monitoring stations across the state of Alaska, and the air quality of most remote Alaskan communities is not being systematically monitored, which hinders our understanding of the relationship between wildfire emissions and human health within these communities. Models simulating the dispersion of pollutants emitted by wildfires can be extremely valuable for providing spatially comprehensive air quality estimates in areas such as Alaska where the monitoring station network is sparse. In this study, we established a methodological framework that is based on an integration of the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model, the Wildland Fire Emissions Inventory System (WFEIS), and the Arctic-Boreal Vulnerability Experiment (ABoVE) Wildfire Date of Burning (WDoB) dataset, an Arctic-oriented fire product. Through our framework, daily gridded surface-level PM2.5 concentrations for the entire state of Alaska between 2001 and 2015 for which wildfires are responsible can be estimated. This product reveals the spatio-temporal patterns of the impacts of wildfires on the regional air quality in Alaska, which, in turn, offers a direct line of evidence indicating that wildfire is the dominant driver of PM2.5 concentrations over Alaska during the fire season. Additionally, it provides critical data inputs for research on understanding how wildfires affect human health which creates the basis for the development of effective and efficient mitigation efforts.

Praise the Gardeners, Dun the Hunters: Alaska Natives, Taxation, and Settler Colonialism

AbstractThis article explores the relationship between tax law and settler colonialism by looking at the ways in which taxes can be part of the “civilizing” process of Indigenous peoples. In 1921, the Territory of Alaska enacted a “license tax on the business of fur-farming, trapping and trading in pelts and skins of fur-bearing animals.” Since most trappers were Natives, the “fur tax” de facto targeted them. This article unpacks the sociocultural and political dimensions of the fur tax against the backdrop of Alaska’s settler colonial history. Despite what the Alaska attorney general claimed was its “strict” revenue-raising function, the tax was part of a much broader settler colonial agenda. That agenda sought to turn semi-nomadic, “uncivilized” Native hunters into spatially grounded, “civilized” farmers, gardeners, reindeer herders, or wage workers. Ultimately, I suggest, within many if not most settler colonial spaces political and sociocultural ideologies alter the initial revenue-raising function of taxes.

Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades.

To evaluate the demographic composition of academic glaucoma specialists currently practicing in the United States. Retrospective and observational study. Academic glaucoma specialists identified from ophthalmology residency programs listed on the Doximity database. The American Board of Ophthalmology (ABO) membership directory, Doximity database, publicly available data, and direct communications were used to identify academic glaucoma specialists and their demographics. Information collected included-name, gender, race/ethnicity, geographic location, board certification date, academic affiliation, and academic rank. Ophthalmic age was defined as the number of years since ophthalmology board certification. Underrepresented minority (URM) groups were defined as Hispanics, Black or African Americans, Latinos, American Indians, or Alaskan Natives as defined by San Francisco match. In addition, the temporal, geographic, and academic rank distributions among females and URMs were explored. Women and URMs representations among academic glaucoma specialists across academic ranks, geographic regions, as well as ophthalmic age. There were 457 active academic glaucoma specialists identified from 110 institutions in 38 states. Among them, 185 (40.5%) were women and 42 (9.2%) were URM. The proportion of women glaucoma specialists in academia had increased significantly with a rate of 1.049 in odds ratio (OR) per year (p < 0.001). However, there were no significant changes in the proportion of URMs over time. The earliest year of certification was 1,964 for males and 1,974 for females. When controlled for ophthalmic age, there were no significant differences in the distribution of women or URMs between the different academic ranks (p = 0.572 and p = 0.762, respectively). Among assistant professors, women had a significantly higher ophthalmic age compared to men (p < 0.001), but there was no significant difference in ophthalmic age in both the associate and full professor groups. There were no significant differences in the geographic distribution of gender (p = 0.516) and URM across United States regions (p = 0.238). The proportion of women among academic glaucoma specialists has significantly increased over the past 5 decades; however, the proportion of URMs has been stagnant in the same period. Enhancing URM representation among academic glaucoma specialists deserves to be a future priority. Afzali K, Fujimoto DK, Mohammadi SO, et al. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract 2023;17(2):98-103.

Unsettling Settler Colonialism in Research: Strategies Centering Native American Experience and Expertise in Responding to Substance Misuse and Co-occurring Sexual Risk-Taking, Alcohol-Exposed Pregnancy, and Suicide Prevention Among Young People.

Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people.

Increasing nonalcoholic fatty liver disease–related mortality rates in the United States from 1999 to 2022

Background: We examined trends in NAFLD-related mortality in the United States from 1999 to 2022, focusing on sex, racial differences, and specific age groups. Methods: We analyzed age-adjusted mortality rates (AAMRs) for NAFLD-related deaths using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database and assessed differences between sex and racial groups. Results: Between 1999 and 2022, NAFLD-related mortality rose from an age-adjusted mortality rate (AAMR) of 0.2 to 1.7 per 100,000, with an average annual percent change (AAPC) of 10.0% (p &lt; 0.001). In all, 85.4% of the cases were reported after 2008. Females (0.2–2 per 100,000, AAPC: 11.7%, p &lt; 0.001) saw a steeper increase than males (0.2–1.3 per 100,000, AAPC: 9.3%, p &lt; 0.001). White individuals’ AAMR rose from 0.2 to 1.9 per 100,000 (AAPC: 10.8%, p &lt; 0.001). Asian or Pacific Islanders (AAPI) increased from 0.2 in 2013 to 0.5 in 2022 (AAPC: 12.13%, p = 0.002), and American Indians or Alaska Natives (AI/AN) from 1 in 2013 to 2.2 in 2022 (AAPC: 7.9%, p = 0.001). African Americans (AA) showed an insignificant change (0.3–0.5 per 100,000, AAPC: 0.7%, p = 0.498). Regarding age, individuals 45–64 saw AAMR rise from 0.3 to 1.2 per 100,000 (AAPC: 6.5%, p &lt; 0.001), and those 65+ from 0.2 to 6 per 100,000 (AAPC: 16.5%, p &lt; 0.001). No change was observed in the 25–44 age group (AAMR: 0.2 per 100,000, AAPC: 0.0%, p = 0.008). Conclusion: We report increased NAFLD-related mortality among both sexes and certain racial groups. The mortality rate increased for older populations, emphasizing the need for targeted public health measures and evidence-based interventions.

Aggregating social benefits of endangered species protection: the case of the Cook Inlet beluga whale

ABSTRACT The Cook Inlet beluga whale (CIBW) is an endangered whale found in waters off the state of Alaska that is protected under the U.S. Endangered Species Act. The federal recovery plan estimates recovery costs will total $73 million (in 2013 dollars). In this study, we use data from a stated preference discrete choice experiment (CE) study to estimate the aggregate benefits of recovering the CIBW and generally for improving its conservation status and reducing extinction risk. Estimated CE models account and test for utility scale heterogeneity, attribute non-attendance, self-selection bias, and demographic effects. Aggregation methods that differ in adjustments made to the mean household welfare and/or to the number of population units are compared by assessing their impact on the resulting aggregate (population-level) welfare estimates. Alaska households are willing to pay between $34 million (95% CI of [$25 million, $44 million]) and $103 million ([$74 million, $131 million]) for full recovery of the CIBW, depending upon the model and aggregation assumptions. While some of the state-level recovery value estimates are below the total cost of combined federal and state recovery actions, accounting for welfare benefits beyond the state of Alaska justifies recovery actions by the benefit–cost criterion.

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females.

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.

Variable trust in public health messaging during the first year of the COVID-19 pandemic in Southeast Alaska

Public health messaging in the United States during the COVID-19 pandemic has been variable in effectiveness. Different levels of governmental institutions have different goals and methods; it is unclear how messaging from these disparate levels is received, trusted, and implemented. We investigate the degrees of trust of Alaska Native and non-Alaska Native people in Southeast Alaska for the U.S. federal, Alaska state, and local Southeast Alaskan governments to parse how Southeast Alaskans feel about relative preparation, actions, and public health messaging. We use data collected in two waves of a regional survey: the first in April-June 2020, and the second in November 2020-February 2021. Results indicate that trust in the federal government was significantly lower than in the Alaska state government for each time period, and trust in both federal and state government significantly decreased between the two periods. Trust in the local governments of Southeast Alaska were significantly higher than both state and federal levels, and increased between the two survey waves, albeit insignificantly. We discuss potential drivers of these observations and outline how this can be leveraged for more comprehensive research into how relatively small communities with a large Native presence perceive public health messaging from different sources.

Russian Colonization of Alaska: From Heyday to Sale, 1818–1867 by Andrei Valterovich Grinev (review)

Reviewed by: Russian Colonization of Alaska: From Heyday to Sale, 1818–1867 by Andrei Valterovich Grinev Erik Hirschmann (bio) Keywords Alaska, Russia, Russian-American Company Russian Colonization of Alaska: From Heyday to Sale, 1818–1867. By Andrei Valterovich Grinev. Trans. Richard L. Bland. (Lincoln: University of Nebraska Press, 2022. Pp. 415. Cloth, $70.00.) This important monograph is the third of a three-volume series on Russian America, and examines the era of Russian naval governors who presided over Russian–American Company (RAC) activities in the North Pacific until the sale of Alaska to the United States in 1867. Professor Grinev's work is a major contribution to the history of the post-1818 era, which is limited to a small number of monographs like Russian America: An Overseas Colony of a Continental Empire, 1804–1867 by Ilya Vinkovetsky (New York, 2011) and Russians in Alaska, 1732–1867 by Lydia Black (Fairbanks, AK, 2004), the latter heavily focused on the pre-1818 era. Like Grinev's first two volumes, which centered on eighteenth-century Russian expansion into Alaska, the 1799 creation of the RAC monopoly, and 1790s–1818 era of colonial governor Alexander Baranov, this third book is grounded in extensive Russian archival research. Appendixes include lists of RAC directors and governors, statistical charts, and translated documents. A glossary of common Russian colonial terms also assists the reader. Missing is a modern map of Alaska's Russian settlements and Alaska Native territories, and the larger North Pacific region. Grinev's engaging narrative centers on several themes pertaining to the problematic long-term viability of Russia's overseas colonies. One is the RAC's paradoxical business relationships with foreigners. Competition with British and American maritime traders over the southeast Alaska fur trade led the tsarist government to ratify 1824–1825 treaties on Alaska's political borders with the U.S. and Britain, permanently halting further Russian territorial expansion in North America. Later, in the 1850s–1860s, American whalers and British smugglers inhibited the RAC's economic prospects in areas of Alaska. In contrast, the RAC profited by leasing the southeast Alaska mainland to the Hudson's Bay Company [End Page 347] (HBC), and conducting ice shipments to San Francisco and fur sales in New York. Another concern for the RAC's longevity was the perceived military vulnerability of Russian Alaska. One important revelation by Grinev is an 1845 document from the RAC Board of Directors to the tsarist minister of finances, where the directors complained about declining revenues and suggested the government might "ultimately abandon the colonies and give them to other nations thirsty for such acquisition for strengthening their dominion" (240). Despite this fear, the RAC's military position in Alaska remained stable during the next few years, including the Crimean War era (1853–1856), thanks to neutrality agreements between the Russian and British governments for the RAC and HBC colonies. Grinev also documents the tsarist government's worry that U.S. citizens on whaling and trading vessels in the 1850s might claim Sakhalin Island, north of Japan. Tsarist officials ordered the RAC to colonize the island, a move that stretched company resources thin. In addition to trade and international geopolitics, Grinev offers valuable insights on the RAC's burgeoning post-1818 administrative apparatus and changing relations with Alaska Natives. The RAC practice of kayurstvo (colonial slavery) toward certain Native orphans and slaves ended by 1822, and payments to Native and Creole (mixed-blood) workers generally improved, as did education and medical care for employees and their dependents. The RAC also explored large areas of the Alaskan interior and established a few modest fur-trading outposts. Perhaps more importantly, the RAC launched initiatives to economically diversify beyond the fur trade, such as coal-mining on the Kenai Peninsula and commercial lumber and fishing in the area around the RAC capital, New Archangel (present-day Sitka). Regarding many of the above developments, Grinev sees the early 1840s management by naval governor Adolf Etolin as "the most favorable period in the history of Russian America" (146). However, the problem of growing RAC expenses outpacing revenues worsened in later years, further compromising the viability of Russian Alaska. While each chapter contains revealing conclusions...

Evaluating racial disparities in central-line–associated bloodstream infections for Tennessee hospitals, 2018–2021

Background: Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee. Methods: CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at P &lt; .05. Data linkage and statistical analyses were performed in SAS version 9.4 software. Results: In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07; P &lt; .0001) when controlling for CCI, age group, and SVI. Conclusions: These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.Disclosures: None