American Indian And Alaska Native Research Articles

Behavioral health services for urban American Indians and Alaska Natives: A thematic analysis of interviews with 10 program directors.

Urban Indian Health Programs (UIHPs) are one of the primary sources of government-funded health care for the millions of American Indian and Alaskan Native (AI/AN) people living in urban areas. The goal of this study is to better understand what services are available at UIHPs and how resources are being used to support these services. Semistructured interviews with behavioral health directors at 10 UIHPs were reported, transcribed, and thematically analyzed to address this knowledge gap. Our analysis indicates that UIHP behavioral health services were broad, encompassing numerous commitments that extend far beyond purely psychotherapeutic interactions and interventions to the periphery of behavioral health. An accurate accounting of behavioral health services at UIHPs must consider not only the ways that these services are shaped by distinctive visions to provide Indigenous cultural education and traditional healing, but also by expansive commitments to offering a full range of social services, case management, and community building under the broad umbrella of behavioral health. Implications of these findings include the need for additional funding for UIHPs, greater sponsorship of pathway training programs for AI/ANs in the mental health professions to increase the availability of AI/AN providers, future expansion of traditional healing practices, and direct empirical observation of behavioral health service delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Healthcare segregation in orthopedic surgery: A statewide analysis of American Indian and Alaska Native patients.

Significant health disparities have been described for American Indian and Alaska Native (AIAN) patients undergoing various surgical procedures, however, research into healthcare segregation within orthopedic surgery has been limited. In this study, our purpose was to assess if AIAN patients were more likely to be treated by lower-volume surgeons and at lower-volume hospitals. AIAN and White patients who underwent one of four common orthopedic procedures (knee or hip arthroplasty, femur or tibia repair) were identified from a Washington state inpatient database. Demographic, socioeconomic, geographic, and procedure data were surveyed, and volumetric thresholds were established for lower versus higher volume surgeons and hospitals. Adjusted odds ratios were calculated for AIAN patients receiving care from a lower volume surgeon or hospital, including covariates for patient demographics, geographic, and socioeconomic status. AIAN patients were more likely to receive care from a lower-volume surgeon for all procedures except tibial repair. Adjusted odds ratios of 1.53 (95% confidence interval [CI]: 1.22, 1.92) and 1.68 (95% CI: 1.26, 2.21) were found for AIAN patients receiving knee or hip arthroplasty from a lower volume surgeon, respectively. There was no strong evidence of AIAN patients being more likely to receive care at a lower-volume hospital. Finally, AIAN patients having knee arthroplasty at a higher volume hospital were more likely to have their surgery performed by a lower volume surgeon. These data suggest that there may be significant healthcare segregation among AIAN patients across common orthopedic surgical procedures.

Food Security and Food Sovereignty: The Difference Between Surviving and Thriving.

Previous research in American Indian and Alaska Native (AI/AN) communities has documented high prevalence of food insecurity. Yet many AI/AN scholars and communities have expressed concerns that the dominant societal conceptions of food security are not reflective of the teachings, priorities, and values of AI/AN communities. Food security initiatives often focus on access to food and, at times, nutrition but little consideration is given to cultural foods, the spirituality carried through foods, and whether the food was stewarded in a way that promotes well-being not just for humans but also for plants, animals, land, and water. Despite the concerns of AI/AN communities that their needs are not centered in dominant societal food conceptualizations and food security programming, the food sovereignty efforts of AI/AN communities have captured national attention as a solution to modern food system inequities. Indigenous Food Sovereignty (IFS) is a holistic approach to food that incorporates values of relationality, reciprocity, and relationships. Fundamental differences exist between food security and food sovereignty, yet dominant society often reduces IFS as a solution to food security, rather than an entirely different food system that is predicated on values that contrast with that of dominant society. Despite calls to decolonize the definition and measurement of food security, we explore whether fixing the concept of food security is a worthy endeavor or whether efforts would be better spent supporting the resurgence and revitalization of AI/AN food values, food knowledge, and community food sovereignty initiatives.

Wellness Tour for Tribal Communities During the COVID-19 Pandemic: Uniting Sacred Space with Western Medicine to Prevent Substance Use

Substance use disorders (SUD) and overdose deaths worsened further during the Covid-19 pandemic in American Indian and Alaska Native (AIAN) communities. The Native Dad’s Network (NDN) delivered the Wellness Tour, offering cultural activities and SUD prevention education, from March 2021 to June 2022, to 11 AIAN tribal communities across California. The in-person program created a “sacred space” through culturally congruent song, dance, and prayer. SUD education included: a lecture about opioids and SUD; group talking circles; an educational skit led by adolescents; and training in naloxone and fentanyl testing strip use along with supplies. After the day-long program, 341 participants agreed strongly on a 5-point Likert type question that it improved their quality of life (mean = 4.7). Among 243 respondents, agreement was strong (mean = 4.8) to two Likert-type questions about cultural relevance and confidence in using naloxone. This AIAN-led program adopted safe practices during the pandemic to deliver culturally congruent SUD prevention education to severely affected AIAN communities.

Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019.

Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.

FRI448 Mother Versus Daughter Attitudes Toward Breastfeeding In American Indians: Implications For Reproductive Health Education

Abstract Disclosure: E.W. Seely: None. J.R. Demirci: None. L.E. Hebert: None. E. Kelty: None. M. heydarpour: None. K. Moore: Consulting Fee; Self; Novo Nordisk. D. Charron-Prochownik: None. Background: Breastfeeding has well established health benefits for mothers and their children, being associated with a reduction in incidence of type 2 diabetes and childhood overweight/obesity. Accordingly, the American Academy of Pediatrics recommends 6 months of exclusive breastfeeding, followed by 1-2 years of continued breastfeeding. American Indian and Alaska Native (AIAN) women have among the lowest rates of breastfeeding of all races/ethnicities in the United States. The low rate is striking given the high rates of type 2 diabetes and obese/overweight AIAN children and young adults. To explore the low breastfeeding rates, we examined breastfeeding attitudes among AIAN mother-daughter dyads at 5 sites (Southwest, Northeast, Plains, and Northwest Coast, U.S.) in data from the Stopping GDM randomized controlled trial (NCT02723266). Methods: We used data collected among 149 mother-daughter dyads, who were asked 7 questions from the CDC’s Infant Feeding Practices Survey II focusing on the importance of breastfeeding and its potential health benefits. An additional question was asked: “If a child was breastfed, he/she will be less likely to get diabetes.” We compared mother/daughter attitudes using Chi-square tests. Results: Mean age + standard deviation of mothers was 44.1 + 9.3 and daughters 16.7 + 3.0 years. Eighty percent of both mothers and daughters agreed or strongly agreed that “Infant formula is not as good as breast milk.” However, attitudes that the best way to feed a baby is breastfeeding and that babies should be exclusively breastfed for the first 6 months were both statistically higher in mothers than daughters (74% vs. 59% and 68% vs. 40%, respectively). Mothers also had significantly higher agreement with the statements that breastfeeding was beneficial for prevention of ear infections (66% vs. 18%), respiratory illness (67% vs. 27%), diarrhea (48% vs. 22%), obesity (42% vs. 12%) and diabetes (35% vs. 13%) than daughters. Conclusion: Significant agreement between mothers/daughters exists for the belief that infant formula is not as good as breast milk. However, daughters’ attitudes toward the benefits of breastfeeding differ significantly from mothers with daughters endorsing weaker beliefs in infant health benefits of breastfeeding. This information is important to design early interventions to increase breastfeeding in AI women by increasing awareness of benefits and eliciting maternal support for adolescents and young adult women prior to planning a pregnancy. Presentation: Friday, June 16, 2023

Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancers: A United States Cohort Study between 2004 and 2017

Brachytherapy (BT) improves clinical outcomes among women with cervical and endometrial cancers. Recent trends found decreasing BT rates in the United States; however, racial/ethnic differences have not been investigated completely. Here we aim to analyze 1) variations in BT practice patterns, 2) racial differences of BT, and 3) predictors of BT by race among women with cervical and endometrial cancers in the United States. A retrospective cohort of women with endometrial and cervical cancers in the US was evaluated using the National Cancer Database, between 2004 and 2017. Primary endpoint was treatment with BT. Women ≥18 years of age were included for FIGO Stage IA-IVA, non-surgically treated cervical cancers and high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers. Racial groups were in accordance with federal guidelines including Asian, American Indian and Alaska Native (AIAN), Black, Native Hawaiian and other Pacific Islander (NHPI), and White. BT practice patterns and trends over time were evaluated by race. To identify predictors of BT by race, logistic regression calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) after assessing for multicollinearity. A total of 13,857 women with cervical cancer and 140,942 women with endometrial cancer were included. Median follow-up was 69 months. Median (IQR) age was 53 (43-63) years for cervical cancer and 64 (57-72) years for endometrial cancer. Most cervical cancers were Stage III (44%), squamous cell carcinoma (88%), and lymphovascular space invasion (LVSI) positive (49%). Most endometrial cancers were Stage IB (45%), endometrioid histology (82%), and LVSI-positive (50%). Between 2004 and 2017, endometrial cancer BT increased (34% to 57%). BT rates for cervical cancer ranged from 65% NHPI, 63% Asian, 62% White, 59% AIAN, and 57% Black. BT rates for endometrial cancer ranged from 26% Black, 25% White, 25% Asian, 21% AIAN, and 20% NHPI. By race, only Black women with cervical cancer were significantly less likely to receive BT (aOR = 0.8; 95% CI = 0.7-0.9), compared to White women. Only NHPI women with endometrial cancer were less likely to receive BT (aOR = 0.7; 95% CI = 0.5-1.0), compared to White women. Community cancer center treatment was the only factor associated with a decreased odds of BT for both Black women with cervical cancer (aOR = 0.7; 95% CI = 0.6-0.9) and NHPI women with endometrial cancer (aOR = 0.3; 95% CI = 0.1-0.8), compared to academic centers. In this study of women diagnosed with endometrial and cervical cancers with stages known to benefit from BT, NHPI women with endometrial cancer and Black women with cervical cancer were less likely to receive brachytherapy compared to White women. Community engagement is needed to increase BT access for patients treated at community cancer centers to ensure equitable gynecologic cancer care.

Culturally tailored digital therapeutic for substance use disorders with urban Indigenous people in the United States: A randomized controlled study

IntroductionIndigenous people experience health disparities, including higher rates of substance use disorders (SUDs). Digital therapeutics are a growing platform for treatment services and have the potential to expand access to culturally responsive interventions for Indigenous people. As one of the first randomized controlled trials for SUDs for American Indian and Alaska Native (AI/AN) adults, the aim of this study was to pilot test the efficacy of a culturally tailored intervention among urban Indigenous adults. MethodsThe study used a randomized controlled parallel design of 12 weeks of treatment-as-usual (TAU) (n = 26) versus TAU + Therapeutic Education System-Native Version (TES-NAV) (n = 27) with follow-up assessments at end of treatment and week 24 in an urban outpatient addiction treatment program for Native American adults. TAU consisted of individual/group counseling and cultural activities. The TES-NAV arm comprised TAU + 26 self-directed culturally tailored digital skills-based modules grounded in the community reinforcement approach with contingency management for abstinence and module completion. Primary outcome was longest consecutive weeks of abstinence from drugs and heavy drinking measured using self-report (Timeline Followback) and urine alcohol and drug toxicology screen during 12 weeks of treatment. Secondary outcomes were percent days abstinence during and posttreatment, coping strategies, social connectedness, and substance use and sexual risk behaviors. ResultsThe study enrolled fifty-three (52.8 % male) AI/AN adults seeking treatment for a SUD. Although the study did not detect a benefit of TAU+TES-NAV over TAU on the primary outcome (Median = 2 consecutive weeks of abstinence for both arms) at end of treatment (treatment effect: Z = −0.78, p = 0.437), TAU+TES-NAV participants did demonstrate significantly greater percent days of abstinence at the week 24 follow-up (69.3 % versus 49.0 % for TAU; t = 2.08, p = 0.045) and significantly greater change in social connectedness mean score, baseline to week 12 (Z = −2.66, p = 0.011), compared to TAU. The study detected no differences between treatment arms for coping strategies or risk behaviors. ConclusionThe addition of TES-NAV to TAU did not significantly improve consecutive weeks of abstinence from drugs or heavy drinking; however, several secondary findings suggest promise for a culturally tailored digital therapeutic SUD intervention among urban Indigenous people. Clinical Trials.Gov registration#NCT03363256.

Minimizing the Consequences of Neonatal Abstinence Syndrome in the American Indian and Alaska Native Populations of California

The opioid epidemic has had a consequential impact on the health of the infant population as many are born with neonatal abstinence syndrome (NAS). Babies born with NAS suffer from many developmental and physical consequences following prenatal exposure to opioids. Specifically, the American Indian and Alaska Native (AI/AN) populations are disproportionately affected by this in California with significantly higher cases of NAS compared to other racial groups. This research focuses on the consequences of NAS as well as an assessment of the current programs in place to support the AI/AN population. Using a combination of extensive literature review as well as, evaluating sources for the government programs for aiding the AI/AN population with opioid addiction, it is concluded that the current programs are insufficient in providing culturally relevant approaches. Further implementation of more accessible and culturally centered programs for the AI/AN population to decrease the effects of the opioid epidemic are necessary.

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust.

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

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.

The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.

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.

Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students.

In the American Indian and Alaska Native (AIAN) population there is a discrepancy between high rates of mental health needs and low utilization rates of mental health services. This study sought to explore whether historical trauma and racial discrimination are associated with health care system (HCS) distrust and negative attitudes toward seeking mental health services. Participants were AIAN college students (n = 392) who completed a cross-sectional online survey. A sequential mediation analysis examined whether historical trauma (thoughts and associated symptoms) was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. A second mediation analysis examined whether perceived racial discrimination was associated with less favorable attitudes toward seeking mental health services, and whether distrust of the HCS mediated this association. Greater reported historical trauma (thoughts and associated symptoms) and racial discrimination were associated with greater distrust of the HCS, which in turn was associated with less favorable attitudes toward seeking mental health services. Perceived racial discrimination was also directly associated with less favorable attitudes toward seeking mental health services. Historical trauma and perceived racial discrimination appear to contribute to less favorable attitudes toward seeking mental health services through their association with distrust of the HCS. This suggests that attempts to address the underutilization of mental health services in the AIAN population should consider the potential roles of historical trauma, racial discrimination, and distrust. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012.

This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.

Using Participatory Research to Develop a Culturally Responsive Early Childhood Assessment Tool

Early childhood educators are uniquely positioned to advance equity by providing culturally-responsive early learning environments and developing respectful and reciprocal relationships with families. Culturally-responsive teaching practices recognize the diverse cultures of children and families as strengths and empower children through cultural values of their family heritage (Gay, 2010). One early childhood program serving Alaska Native and American Indian (AN/AI) children and families identified a need to more systematically support educators’ reflection on their knowledge, skills, and abilities related to cultural programming. This paper aims to describe the process of and lessons learned from using a participatory, community-based research approach to develop a culturally-responsive early childhood assessment tool. Operating from a postmodern/transformative paradigm, we describe the journey of this process with particular attention to shifting power to the community participants and carefully attending to our own reflexivity as three white researchers collaborating with a tribal non-profit organization.

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.

American Indian and Alaska Native substance use treatment: Barriers and facilitators according to an implementation framework

IntroductionSubstance use disorder (SUD) and overdose deaths are higher in the American Indian and Alaska Native (AIAN) population than in other racial/ethnic groups. Multi-level gaps hinder SUD treatment for AIAN patients. Few studies have engaged front-line clinicians and administrators of SUD treatment programs serving AIAN patients to identify barriers and facilitators to improve the implementation of effective treatment. MethodsWe conducted key informant interviews with a diverse sample of providers and administrators of SUD treatment programs across California regarding barriers and facilitators to treatment for AIAN patients. An AIAN-majority community advisory board (CAB) guided the development of an interview guide and helped to recruit respondents from five types of SUD programs statewide. Using ATLAS.ti, the research team coded interviews and classified emergent themes as barriers and facilitators related to Outer, Inner, and Individual domains of the Consolidated Framework for Implementation Research (CFIR). ResultsRepresentatives of 13 of 15 invited SUD treatment programs participated and 9 of the 13 interviewed self-identified as AIAN. Related to Outer Setting barriers from coded interviews, a dominant barrier was policies that defund or underfund SUD treatment, especially detoxification centers. Outer Setting facilitators included consistent Indian Health Service (IHS) eligibility criteria, judicial system connections for direct treatment access, and community programs advocating SUD treatment. Key themes related to barriers for the Inner Setting were limited bed capacity, poor coordination of intake and care, and lack of telehealth technology. Facilitators integrated mental health, linkage to external resources, and culturally centered care. Individual-level barriers were negative attitudes such as SUD stigma, distrust of governmental programs, and lack of transportation while individual engagement was facilitated by programs addressing negative attitudes and providing telemedicine for remote care. ConclusionThe public health threat of SUD for the AIAN population mandates the implementation of interventions and policies that facilitate care. This qualitative study with primarily AIAN clinical leaders of SUD treatment highlights opportunities to improve care at multiple CFIR levels, focusing on capacity, coordination, culturally congruent care, and community initiatives to promote engagement.

Racial disparities in survival and stage at diagnosis among adolescent and young adult patients with cancer.

6615 Background: Adolescent and young adult (AYA) patients (15-39 years) are an underrecognized population with high risk of select malignancies. Compared to pediatric and adult patients, AYA patients have not achieved improvements in cancer survival. No studies have evaluated overall survival (OS) and stage at diagnosis among all 5 federally recognized races in the US. Here we aim to investigate OS and stage at diagnosis among AYA patients by race. Methods: A retrospective cohort study of AYA patients diagnosed between 2004-2017 was conducted with the National Cancer Database. Patients with the 10 deadliest AYA cancers with at least 6 months of follow-up were included. Primary endpoints were OS (time from diagnosis to death) and late stage at diagnosis (stage III/IV or Grade III/IV for central nervous system [CNS] cancer). Kaplan-Meier estimates and log-rank tests assessed OS. OS and late stage were evaluated by race using multivariable Cox proportional hazard (adjusted hazard ratio [aHR]) and logistic (adjusted odds ratio [aOR]) regressions, respectively, with 95% confidence intervals (95%CI). All regressions were adjusted for sociodemographic and cancer characteristics. Results: 291,899 AYA patients were included: 64% female, 65% stage I/II, and 62 month median follow-up. Cancer sites included 27% breast, 16% lymphoma, 13% melanoma, 11% testis, 9% CNS, 7% colorectal, 7% cervix, 5% sarcoma, 3% ovary, and 2% lung. Race included 82.3% Non-Hispanic White (NHW), 14.0% Black, 2.9% Asian, 0.5% American Indian and Alaska Native (AIAN), and 0.3% Native Hawaiian and other Pacific Islander (NHPI). OS differed for all cancers by race (p<.0001), except for lung (p=.008), CNS (p=.32), and ovary (p=.28). OS was significantly inferior for NHPI, Black, and AIAN but superior for Asian, versus NHW (Table). NHPI had inferior OS (aHR, 95%CI) for melanoma (4.5, 2.0-10.0), colorectal (1.8, 1.3-2.4), lymphoma (1.7, 1.1-2.1), and cervix (1.6, .1-2.4) cancers. Black patients had inferior OS for melanoma (1.6, 1.2-2.2), lymphoma (1.5, 1.4-1.6), and breast (1.4, 1.3-1.4) cancers. Asian patients had superior OS for breast (0.7, 0.7-0.8) and lung (0.7, 0.6-0.9) but inferior survival for testis (1.9, 1.3-2.9) cancers. AIAN patients had inferior OS for colorectal (1.4, 1.0-1.9). Late stage at diagnosis was higher for NHPI, Black, and Asian patients, compared to NHW patients (Table). Conclusions: Both NHPI and Black AYA patients with cancer have higher risk of death and late stage disease at diagnosis, compared to NHW patients. Our data reveal racial disparities among Indigenous AYA patients masked by prior data omission. [Table: see text]