American Indian Males Research Articles

A qualitative exploration of facilitators and barriers to adopting a healthy lifestyle among Black, Hispanic, and American Indian males with diabetes or at risk for type 2 diabetes

ABSTRACT Objectives Higher prevalence of several chronic diseases occurs in men in the United States, including diabetes and prediabetes. Of the 34 million adults with diabetes and 88 million with prediabetes there is a higher prevalence of both conditions in men compared to women. Black, Hispanic, and American Indian men have some of the highest rates of diabetes and diabetes complications. Adopting a healthy lifestyle including healthy eating and physical activity, is important in preventing type 2 diabetes and diabetes complications. Design This study included six focus groups that explored facilitators and barriers to adopting a healthy lifestyle in Black, Hispanic, and American Indian men with diabetes or at risk for type 2 diabetes. Thematic analysis was used to identify facilitators and barriers to adopting a healthy lifestyle. Results Participants included males 18 years of age and older identifying as Black, Hispanic, or American Indian and diagnosed with prediabetes, diabetes, hypertension, or otherwise at risk for type 2 diabetes. Thirty-seven men participated, 19 diagnosed with diabetes and 18 at risk for type 2 diabetes. Fourteen Black, 14 Hispanic, and 9 American Indian men participated. The themes of facilitators to a healthy lifestyle included: family and the social network; psychosocial factors; health status, health priorities and beliefs about aging; knowledge about health and healthy behavior; and healthy community resources. Themes of barriers to a healthy lifestyle also included: mistrust of the health care system, cost, and low socioeconomic status. Conclusions This study underscores the complexity of factors involved in adopting a healthy lifestyle for some racial and ethnic minority men with diabetes or at risk for type 2 diabetes.

Abstract 1313: Racial disparities in colorectal cancer incidence across US ethnic groups: A comprehensive analysis

Abstract Colorectal cancer (CRC) ranks as the third most prevalent global cancer and the fourth leading cause of cancer-related deaths. Racial disparities in CRC within the United States pose a significant public health concern, affecting incidence, mortality rates, and screening rates. This study investigates the impact of racial disparities on CRC incidence across various US states, utilizing CRC data from the National Cancer Institute (NCI) at the Centers for Disease Control and Prevention (CDC). Analysis with GraphPad Prism 5 software and Student's t-test reveals a consistent trend of higher CRC incidence in males compared to females, irrespective of ethnicity. Notably, the Black and American Indian ethnic groups demonstrate the highest CRC incidences among all races, especially in individuals aged 65 and above. Certain states, including Iowa and Mississippi for Black populations, and Alaska, Minnesota, Montana, Oklahoma, and South Dakota for American Indian populations, exhibit significantly elevated CRC incidences compared to the national average. County-specific analysis in Alabama reveals varying CRC incidence rates across ethnic groups, with higher rates in specific counties, such as Clarke County for Black males. Limited reports for American Indian, Asian Pacific, and Hispanic ethnic groups indicate potential disparities in access to testing, awareness, and funding for CRC detection and prevention. This study concludes that Black and American Indian males and females experience a higher incidence of colorectal cancer, possibly influenced by genetic factors or other variables contributing to CRC development. The observed disparities are multifaceted, arising from a combination of social, economic, and healthcare system factors. Addressing these complexities is crucial for mitigating CRC disparities and promoting equitable healthcare access and outcomes. Additional research, including molecular screening studies, is essential to substantiate disparities in cancer-related health and enhance public health and cancer awareness within the community. Key Words: Cancer, Colorectal Cancer, Health Care, Racial Disparities Citation Format: Anathbandhu Chaudhuri, Rosianna Gray. Racial disparities in colorectal cancer incidence across US ethnic groups: A comprehensive analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1313.

Low-Value Prostate-Specific Antigen Screening in Older Males

The US Preventive Services Task Force guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in males older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. However, this low-value PSA screening in males aged 70 years or older remains common. To characterize the factors associated with low-value PSA screening in males 70 years or older. This survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention that collects information via telephone from more than 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. The final cohort comprised male respondents to the 2020 BRFSS survey who were categorized into the following age groups: 70 to 74 years, 75 to 79 years, or 80 years or older. Males with a former or current prostate cancer diagnosis were excluded. The outcomes were recent PSA screening rates and factors associated with low-value PSA screening. Recent screening was defined as PSA testing within the past 2 years. Weighted multivariable logistic regressions and 2-sided significance tests were used to characterize factors associated with recent screening. The cohort included 32 306 males. Most of these males (87.6%) were White individuals, whereas 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic individuals. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were aged 75 to 79 years, and 28.9% were 80 years or older. The recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. Among all racial groups, non-Hispanic White males had the highest screening rate (50.7%), and non-Hispanic American Indian males had the lowest screening rate (32.0%). Screening increased with higher educational level and annual income. Married respondents were screened more than unmarried males. In a multivariable regression model, discussing PSA testing advantages with a clinician (odds ratio [OR], 9.09; 95% CI, 7.60-11.40; P < .001) was associated with increased recent screening, whereas discussing PSA testing disadvantages had no association with screening (OR, 0.95; 95% CI, 0.77-1.17; P = .60). Other factors associated with a higher screening rate included having a primary care physician, a post-high school educational level, and income of more than $25 000 per year. Results of this survey study suggest that older male respondents to the 2020 BRFSS survey were overscreened for prostate cancer despite the age cutoff for PSA screening recommended in national guidelines. Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males.

Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999-2020.

The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25-54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis.

Vital Signs: Changes in Firearm Homicide and Suicide Rates - United States, 2019-2020.

IntroductionThe majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020.MethodsNational vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty.ResultsFrom 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10–44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25–44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10–44 years, rates did increase.Conclusions and Implications for Public Health PracticeDuring the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.

Striving and Thriving: A Life Course Trade-Off?

Striving and Thriving: A Life Course Trade-Off?

Racial disparities in preventable risk factors for head and neck cancer

To demonstrate racial differences in preventable risk behaviors/practices that contribute to head and neck cancer (HNCA). Cross-sectional analysis of large national risk factor survey. The Behavioral Risk Factor Surveillance System for 2013 was analyzed. Demographic data were extracted, including age, sex, and race. Social habits considered risk factors for HNCA were also extracted, including alcohol consumption, smoking, and human papillomavirus (HPV) vaccination status. Statistical comparisons were conducted according to race for each risk factor, and additional comparisons were conducted within the American Indian population subgroup for risk factors according to sex. A total of 238.6 million Americans were surveyed. American Indians reported higher rates of binge drinking (19.0%) than whites (17.3%), blacks (12.4%), and Asian Americans (13.1%; P < .001). This rate was significantly higher for American Indian males (23.5%) versus females (13.7%; P < .001). Mean total drinks per month was higher for whites and American Indians (13.5 and 13.5; P < .001). American Indians reported the highest rates of current smoking (28.1%), followed by blacks (20.1%), whites (18.3%), and Asians (10.2%; P < .001). American Indians also reported the highest rates of every day smoking (18.2%), versus whites (13.3%), blacks (13.1%), and Asians (6.1%; P < .001). Rates of HPV vaccination were lowest for American Indians (11.7%), compared to whites (14.6%), blacks (13.6%), and Asians (12%; P = 0.618). There are striking racial disparities in the prevalence of preventable risk factors for HNCA. These data highlight the need for targeted education and prevention programs in particular racial groups. 4. Laryngoscope, 127:1068-1072, 2017.

Smoking Trajectories Among Monoracial and Biracial Black Adolescents and Young Adults.

Cigarette smoking trajectories were assessed among monorace Blacks, Black-American Indians, Black-Asians, Black-Hispanics, and Black-Whites. We used a subsample of nationally representative data obtained from the National Longitudinal Study of Adolescent Health (Add Health). The sample consisted of adolescents who were in Grades 7 - 12 in 1994, and followed across four waves of data collection into adulthood. Wave 4 data were collected in 2007-2008 when most respondents were between 24 and 32 years old. Respondents could report more than one race/ethnicity. Poisson regression was used to analyze the data. We found distinct smoking trajectories among monorace and biracial/ethnic Blacks, with all groups eventually equaling or surpassing trajectories of Whites. The age of cross-over varied by gender for some subgroups, with Black-American Indian males catching up earlier than Black-American Indian females. Black-White females smoked on more days than monorace Black females until age 26 and also smoked more than Black-White males between ages 11 and 29 years. Black-Hispanic males smoked on more days than Black-Hispanic females from ages 11 to 14. The results of the interaction tests also indicated different smoking trajectories across SES levels among White, Black, and Black-White respondents. Significant heterogeneity was observed regarding smoking trajectories between monoracel and biracial/ethnic Blacks. Knowledge of cigarette smoking patterns among monorace and biracial/ethnic Black youth and young adults extends our understanding of the etiology of tobacco use and may inform interventions.

American Indian Male College Students Perception and Knowledge of Human Papillomavirus (HPV)

The authors explored American Indian male college students’ HPV attitudes, perceptions and knowledge of HPV prevention and transmission. Eight focus groups with male and female students ages 19-26 were conducted at four Southwest universities. Audio recordings were transcribed and analyzed using Grounded Theory methods. American Indian males reported little or no responsibility for HPV prevention and transmission (p=0.048) and held poor personal risk perception (p=0.0001). Male students also had low levels of HPV knowledge (p=0.003) and lenient attitudes, indicating an overall disregard for safer sexual practices. Misinformation regarding HPV vaccination played a significant part in their lack of intention to modify sexual behaviors. Cultural barriers to obtaining HPV information and sources of HPV education were identified, as was preference for receiving HPV information. We recommend school-based culturally sensitive HPV prevention programs that focus on improving responsible safer sexual practices by educating students in activities to reduce cancer and STI disease burden. Emphasis on preventing genital warts, other STIs, as well as HPV-related cancers found in males and females may increase acceptability and responsibility of HPV prevention measures among male American Indian students.

Unintentional drug overdose death trends in New Mexico, USA, 1990–2005: combinations of heroin, cocaine, prescription opioids and alcohol

To determine the contribution of heroin, prescription opioids, cocaine and alcohol/drug combinations to the total overdose death rate and identify changes in drug overdose patterns among New Mexico subpopulations. We analyzed medical examiner data for all unintentional drug overdose deaths in New Mexico during 1990-2005. Age-adjusted drug overdose death rates were calculated by sex and race/ethnicity; we modeled overall drug overdose death adjusting for age and region. The total unintentional drug overdose death rate in New Mexico increased from 5.6 per 100 000 in 1990 to 15.5 per 100 000 in 2005. Deaths caused by heroin, prescription opioids, cocaine and alcohol/drug combinations together ranged from 89% to 98% of the total. Heroin caused the most deaths during 1990-2005, with a notable rate increase in prescription opioid overdose death during 1998-2005 (58%). During 1990-2005, the 196% increase in single drug category overdose death was driven by prescription opioids alone and heroin alone; the 148% increase in multi-drug category overdose death was driven by heroin/alcohol and heroin/cocaine. Hispanic males had the highest overdose death rate, followed by white males, white females, Hispanic females and American Indians. The most common categories causing death were heroin alone and heroin/alcohol among Hispanic males, heroin/alcohol among American Indian males and prescription opioids alone among white males and all female subpopulations. Interventions to prevent drug overdose death should be targeted according to use patterns among at-risk subpopulations. A comprehensive approach addressing both illicit and prescription drug users, and people who use these drugs concurrently, is needed to reduce overdose death.

INTERSTITIAL CYSTITIS, CHRONIC NONBACTERIAL PROSTATITIS AND CHRONIC PELVIC PAIN SYNDROME IN MEN: A COMMON AND FREQUENTLY IDENTICAL CLINICAL ENTITY

In this ongoing review we characterize interstitial cystitis in men, identifying multiple clinical factors in the diagnosis and treatment of men with interstitial cystitis. An ongoing and retrospective chart review of 92 men with interstitial cystitis within our large single specialty practice was performed. Presenting complaints, duration of symptoms, epidemiology, and clinical and physical findings were reviewed. All patients met National Institute for Diabetes and Digestive and Kidney Diseases criteria for the diagnosis of interstitial cystitis. Of the patients 83% were white and 17% were American Indians of Cherokee descent. Average patient age at diagnosis was 51 years and average duration of symptoms was 8.8 years. The most commonly reported initial complaints were mild suprapubic discomfort, which rapidly progressed in an average of 21/2 years to severe suprapubic discomfort, severe dysuria and severe urinary frequency. Sexual dysfunction occurred in 60% of patients with painful ejaculation. The most common physical findings were suprapubic tenderness to palpation and anterior rectal wall tenderness on digital rectal examination. Of the patients 40% had microscopic hematuria. All patients demonstrated severe glomerulations under anesthesia with cystoscopy and hydraulic distention of the bladder. Average bladder volume was 510 cc. Interstitial cystitis in males appears to be more common than historically reported. Interstitial cystitis in males and patients with chronic pelvic pain syndrome and chronic nonbacterial prostatitis share many clinical findings. A higher incidence of interstitial cystitis had been found in American Indian males of Cherokee descent and deserves further investigation.

Health Risk-Factors for Gay American Indian and Alaska Native Adolescent Males

ABSTRACT Having multiple identities as a homosexual American Indian or Alaska Native adolescent male increases the likelihood for poorer health and diminished well-being. This study assessed the differences in self-perceived health status between gay adolescent males and their heterosexual counterparts. A national nonrepresentative sample of 5,602 Indian and Native adolescent males was surveyed about issues of sexual behavior, physical and sexual abuse, mental health status, substance use, attitudes about school, participation in violence, and access to health care. Results indicate that there were no real differences between gay and heterosexual male respondents for substance use or attitudes about school. Statistically significant differences were found, however, in areas of mental health, as well as physical and sexual abuse. Gay adolescents were twice as likely to have thought of or attempted suicide. Gay adolescents were twice as likely to have been physically abused and nearly six times more likely to have been sexually abused. Gay American Indian or Alaska Native adolescent males constitute a very vulnerable population and are clearly in need of targeted health and social services. Unfortunately, the benefits seen by adults of the “two-spirited” gay and lesbian American Indian movement have not been accessible to Indian and Native adolescents.

Relationship of Binge Drinking to Alcohol Dependence, Other Psychiatric Disorders, and Behavioral Problems in an American Indian Tribe

The hypothesis that binge drinking is a benign behavior not associated with alcohol dependence, other psychiatric disorders, or problem areas, in American Indians, was tested in a sample of 582 adult Southwestern American Indian males and females in large multigenerational pedigrees. All information was obtained from semistructured psychiatric interviews that were independently blind-rated for DSM-III-R diagnoses. Three main outcome measures were used: the relationship between binge drinking and (1) alcohol dependence and other psychiatric disorders, (2) substance abuse treatment, and (3) four behavioral problem categories-violence/lawlessness, physical, social, and work. Binge drinking and alcohol dependence were strongly associated. Most binge drinkers were diagnosed as alcohol dependent. However, when controlling for alcohol dependence and other covariates, binge drinking was independently associated with an increase in odds for positive diagnoses for multiple psychiatric disorders, and for social, work, physical, and violence/lawlessness behavioral problems. In sum, binge drinking was found to be a common and severe problem with deleterious consequences in multiple domains of functioning. Assessment instruments should be designed to elicit information on binge patterns of drinking and strategies devised to provide appropriate treatment.

Volatile Solvent Use: Patterns by Gender and Ethnicity Among School Attenders and Dropouts

SUMMARY Differences in patterns of volatile solvent use were explored with special emphasis on use as related to school enrollment status. The sample included American Indian, Mexican-American and White American youth. Furthermore, three enrollment status categories were identified: dropout, academically at-risk (enrolled), and control. A self report survey was used to assess both level and intensity of volatile solvent use. Findings indicated that a higher proportion of the dropout cohort have used volatile solvents, used volatile solvents regularly, and used volatile solvents with more intensity than either the academically at-risk group or the control group. An interaction between gender and ethnicity was also revealed; American Indian females reported higher lifetime prevalence and thirty-day prevalence than did American Indian males, whereas for both the Mexican-American and White American samples, males report higher rates than females. Findings are discussed in terms of the influence of volatile so...

Rural wages and returns to education: Differences between whites, blacks, and American Indians

This paper examines racial and gender wage differences for rural workers. Its contribution is twofold, with a broadening of the existing research regarding rural workers, and its new evidence of the structure of wages faced by American Indians. The results show that with the rural focus, American Indian males and Black females experience the weakest wage returns to education within their respective genders. However, merely examining employment and wage rates, American Indians and Blacks of both genders face an economic disadvantage relative to Whites. Examining wage gaps, gender differences are more striking. Females face smaller actual majority/minority wage gaps, but more of the gap remains unexplained by personal and job characteristics. In other words, male wage gaps are driven more by differences in characteristics, while female wage gaps are driven more by difference in returns. This implies that discrimination is more prevalent in the rural female labor market, although its actual effect on wages is smaller.

Attributional Antecendents of Alcohol Use in American Indian and Euroamerican Adolescents

American Indian and Euroamerican adolescents were compared in regard to the events that they saw as responsible for their alcohol use. American Indian males believed that heredity played a more important role in their use of alcohol than Euroamerican males. American Indian males also believed that fate was a more important influence on their use of alcohol than American Indian females and Euroamerican females and that environmental events (e.g., problems at home) were a less important influence than the three other groups. Euroamerican females saw distressing events as more responsible for their alcohol use than the American Indian females and Euroamerican males. Euroamerican females also saw themselves as more responsible for their alcohol use than the American Indian females and males and Euroamerican males. The treatment implications of these attributional differences in reasons for alcohol use are discussed, especially in regard to American Indian adolescent males.

Changing trends in mortality among New Mexico's American Indians, 1958-1987.

Health care availability and living conditions have improved substantially for American Indians in New Mexico over the past quarter century. To investigate the impact of these changes on health statistics, we examined mortality data collected from 1958 to 1987 for American Indians in the state. We analysed the data for all causes of death combined and for specific causes, and compared these data with figures for nonHispanic whites in the state. Age-adjusted mortality rates were calculated for 5-year periods for each ethnic-gender group, using denominators from US Census reports. Mortality rates for all causes combined did not improve significantly for American Indian males from 1958 to 1987, although the rates for American Indian females showed an 8% decline. Infectious disease-related mortality rates for American Indians decreased dramatically over the 30-year study period; however, mortality rates for cancer and diabetes increased over the 30-year period. Mortality rates for injuries and alcoholism among American Indians increased greatly from 1958 to 1977 and then declined later in the study period, but they were consistently higher than rates for whites. The study indicates that several chronic diseases remain of major public health importance for New Mexico's American Indian population.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/ deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Locus of Control and Drinking Behavior in American Indian Alcoholics and Non-Alchoholics

Many investigators have attempted to determine whether alcoholics differ from non-alcoholics in their perceived locus of control. The present study examined the responses of alcoholic and non-alcoholic American Indian males and females on Levenson's Multidimensional Locus of Control Scale. Subjects were 80 American Indian males and 40 American Indian females. All subjects were members of either an eastern (Cherokee) or western (Cheyenne) Oklahoma tribe. Results indicate no significant differences between the Cherokee male alcoholic and non-alcoholic group. Cheyenne male alcoholics reported significantly lower internal control scores than did Cheyenne male non-alcoholics. Within the female sample, alcohol use and tribal membership showed a significant interaction with locus of control. These findings suggest that locus of control may be a potentially useful clinical construct in the development of treatment plans and therapeutic issues for American Indian patients who are alcoholics.

Race, sex, and juvenile inmate roles

The issue of inmate roles in the socialization of adult offenders confined in correctional institutions has had lengthy analysis and deliberation. The way inmate roles are used by juvenile offenders as a method of coping with and adjusting to confinement in a training school parallels many of the socialization functions of inmate roles found in adult institutions. This study examines seven adjustment patterns of confined offenders in a juvenile correctional system located in a southeastern state. Significant differences occur between various combinations of sex and race categories in terms of participation in different types of aggressive roles, manipulative roles, and passive roles. White males and black males appear at opposite ends of a dominance‐exploitation spectrum. Black males, American Indian males, and black females tend to use aggressive inmate roles and thereby dominate life within the inmate social system. White males and Indian females employ passive and manipulative roles in order to cope wi...