American Indian Research Articles

Longitudinal lipidomic profiles of left ventricular mass and hypertrophy in American Indians.

Left ventricular hypertrophy (LVH) and dyslipidemia are strong, independent predictors for cardiovascular disease, but their relationship is less well-studied. A longitudinal lipidomic profiling of left ventricular mass (LVM) and LVH is still lacking. Using LC-MS, we repeatedly measured 1,542 lipids from 1,755 unique American Indians attending two exams (mean~5-year apart). Cross-sectional associations of individual lipid species with LVM index (LVMI) were examined by generalized estimating equation (GEE), followed by replication in an independent bi-racial cohort (65% white, 35% black). Baseline plasma lipids associated with LVH risk beyond traditional risk factors were identified by Cox frailty model in American Indians. Longitudinal associations between changes in lipids and changes in LVMI were examined by GEE, adjusting for baseline lipids, baseline LVMI, and covariates. Multiple lipid species (e.g., glycerophospholipids, sphingomyelins, acylcarnitines) were significantly associated with LVMI or the risk of LVH in American Indians. Some lipids were confirmed in black and white individuals. Moreover, some LVH-related lipids were inversely associated with risk of coronary heart disease (CHD). Longitudinal changes in several lipid species (e.g., glycerophospholipids, sphingomyelins, cholesterol esters) were significantly associated with changes in LVMI. These findings provide insights into the role of lipid metabolism in LV remodeling and the risk of LVH or CHD.

American Indian census rolls: An underutilized source of historical demographic information on tribal populations

Historical information on tribal populations in the United States is incomplete. American Indians and Alaska Natives were not enumerated with the general population until the 1940 decennial census. However, Indian Census Rolls were produced for the period 1885 – 1940 under the auspices of the Bureau of Indian Affairs in the U.S. The information given in the Indian Census Rolls varies but usually includes the roll number, age, gender, tribal identity, and relationship to the head of the family. In this paper, we present background information on Indian Census Rolls and demonstrate how the digitized microfiche census roll schedules can be assembled into an Excel file. We also provide examples of the potential uses of Indian Census Rolls. We conclude that Indian Census Rolls can not only help bridge the gaps in the historical demography of American Indians but also provide the basis for a clearer picture of the current and future demographic characteristics of American Indians.

Suicidal Thoughts and Behaviors in American Indian and Alaska Native Adolescents.

American Indians and Alaska Natives (AI/AN) have consistently exhibited suicide rates that surpass all other racial and ethnic groups in the United States. However, not much has been published regarding the epidemiology of AI/AN youth suicides. The objectives of this study on AI/AN adolescents were to assess the prevalence of suicidal thoughts and behaviors by age and gender, assess the number of years of life lost to suicide before the age of 80, and assess the most common methods used to commit suicide by AI/AN adolescents. Data utilized for this study were from the national Youth Risk Behavior Surveys and the Web-Based Injury Statistics Query and Reporting System. We conducted a cross-sectional descriptive analysis of the suicide-related data from years 2015, 2017, 2019, and 2021. We found AI/AN adolescents averaged one in four contemplated suicides, one in five planned suicides, and one in six attempted suicides. A total of 257 adolescents committed suicide during the study period where the majority (62.5%) were observed in males and suicides were more common in older adolescents. AI/AN adolescents had the highest crude suicide death rate of any racial or ethnic group and the most common methods used to commit suicide were suffocation (57.5%) and firearms (35.5%). AI/ AN adolescents lost almost 16,000 years of potential life during the four years of the study and the majority were lost by males. Professionals and policymakers desiring to reduce suicidal thoughts and behaviors among AI/AN adolescents need to focus more of their efforts on providing youths with resilience factors to establish sufficient ego strength in them to deal with all types of stressors. Concurrently, federal, state, and tribal leaders need to work together to improve the social and economic circumstances faced by many AI/AN families and children.

Pediatric non-nasopharyngeal head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results (SEER) program with review of the literature

BackgroundDespite its prevalence in adults, head and neck squamous cell carcinoma (HNSCC) is considered a rare entity in pediatrics where lymphomas, neural tumors, and soft tissue sarcomas predominate in the head and neck. Given the association of squamous cell carcinoma with the human papillomavirus, a risk factor that may be present from birth, and the difficulties in staging this disease for prognostication in children, it is important to revisit nationally collected data for prevalence and outcomes assessments. ObjectiveTo examine a publicly available national database to describe the incidence, pathology, treatment, and survival of pediatric HNSCC. To review the available literature regarding management, outcomes, and risk factors for this disease process. MethodsThe National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor database was queried to identify pediatric subjects ages 0 to 19 diagnosed HNSCC between 1973 and 2019. ResultsTwo-hundred ninety-two cases were identified. Subjects were 62.7 % male (n = 183) and the average age was 15.4 years (range 2–19, median 16). Subjects were 65.8 % white (n = 192), 22.9 % black (n = 67), 8.9 % Asian/Pacific Islander (n = 26), 1 % American Indian (n = 3), and 1.4 % unknown (n = 4). The most common primary sites were nasopharynx (45.9 %), oral cavity (30.5 %), larynx (8.6 %), salivary gland (4.1 %), nasal cavity & paranasal sinus (3.4 %), and lip (2.7 %). There was no statistically significant difference between primary subsite and age, race, histologic grade, or extent of disease. The 5-year overall survival was 83.6 %. DiscussionHead and neck squamous cell carcinoma is more likely to present in older children and is more prevalent in White populations. The nasopharynx is the most common subsite involved, which differs from adult populations in which non-nasopharyngeal subsites including the larynx, oral cavity, and oropharynx are most frequently affected. ConclusionHead and neck squamous cell carcinoma is rare in pediatric patients but should not be overlooked by physicians in the differential diagnosis, particularly in teenagers. Further study is needed to determine whether this represents a unique entity or can be staged and treated according to adult guidelines.

"Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients".

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking. We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time. In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001). Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.

Did Biden-Harris’s reforms on the Paycheck Protection Program reduce racial disparities in lending?

AbstractIntroduced under the Trump-Pence Administration, the Paycheck Protection Program (PPP) provided short-term relief loans to small American businesses during the peak of the Coronavirus pandemic. The initial design of the PPP faced significant criticism from researchers due to racial disparities, among other issues, in its lending process. Minority groups received smaller PPP loan amounts during the original two tranches released in 2020. To increase equitable access for all, in February 2021 the Biden-Harris Administration enforced swift changes to the initial PPP aimed at favouring access to PPP loans for minority-owned small businesses that had been disadvantaged by the program’s original design under the Trump-Pence Administration. By exploiting a granular dataset of 1,759,270 PPP loans granted between Q2 2020 and Q2 2021 and by implementing a difference-in-differences approach (DID), this paper provides novel evidence on the effectiveness of the Biden reforms in reducing racial disparities within the Paycheck Protection Program. Indeed, we observe a significant increase in the volume of PPP loans granted to minority-owned businesses in the period following the Biden-Harris Administration’s reforms. Furthermore, among different minority groups, the reforms appear most effective for Native American minority groups (including American Indians, Alaska Natives, Native Hawaiians and/or Other Pacific Islanders), followed by Black Americans and Asian business owners. Our findings offer novel contributions to the existing literature on institutional discrimination, particularly regarding the initial PPP design. Our findings are especially valuable for policy makers as they underscore the importance of radical changes in addressing racial disparities. Our paper also offers evidence of how a public credit guarantee program should be designed to empower and promote economic inclusion for all, regardless of ethnicity, aligning with the UN’s Sustainable Development Goals.

Performance of Machine Learning Suicide Risk Models in an American Indian Population

Few suicide risk identification tools have been developed specifically for American Indian and Alaska Native populations, even though these populations face the starkest suicide-related inequities. To examine the accuracy of existing machine learning models in a majority American Indian population. This prognostic study used secondary data analysis of electronic health record data collected from January 1, 2017, to December 31, 2021. Existing models from the Mental Health Research Network (MHRN) and Vanderbilt University (VU) were fitted. Models were compared with an augmented screening indicator that included any previous attempt, recent suicidal ideation, or a recent positive suicide risk screen result. The comparison was based on the area under the receiver operating characteristic curve (AUROC). The study was performed in partnership with a tribe and local Indian Health Service (IHS) in the Southwest. All patients were 18 years or older with at least 1 encounter with the IHS unit during the study period. Data were analyzed between October 6, 2022, and July 29, 2024. Suicide attempts or deaths within 90 days. Model performance was compared based on the ability to distinguish between those with a suicide attempt or death within 90 days of their last IHS visit with those without this outcome. Of 16 835 patients (mean [SD] age, 40.0 [17.5] years; 8660 [51.4%] female; 14 251 [84.7%] American Indian), 324 patients (1.9%) had at least 1 suicide attempt, and 37 patients (0.2%) died by suicide. The MHRN model had an AUROC value of 0.81 (95% CI, 0.77-0.85) for 90-day suicide attempts, whereas the VU model had an AUROC value of 0.68 (95% CI, 0.64-0.72), and the augmented screening indicator had an AUROC value of 0.66 (95% CI, 0.63-0.70). Calibration was poor for both models but improved after recalibration. This prognostic study found that existing risk identification models for suicide prevention held promise when applied to new contexts and performed better than relying on a combined indictor of a positive suicide risk screen result, history of attempt, and recent suicidal ideation.

Diagnosable mental disorders among American Indians and Alaska Natives in the United States: A scoping review.

Diagnosable mental disorders among American Indians and Alaska Natives in the United States: A scoping review.

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations. To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities. This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023. COVID-19 PHE period (March 2020 to May 2023). All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE. For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

Trends in Acute Kidney Injury Related Deaths in the US from 1999 to 2020

Background Acute kidney injury requiring dialysis is linked to long-term care demands, higher hospital mortality, and increased healthcare expenses. We aim to assess nationwide trends and regional variations in acute kidney injury-related mortality in the US. Materials and Methods We used death certificates from the CDC WONDER database (1999-2020) to calculate age-adjusted mortality rates (AAMRs) and annual percent change (APC). The data were stratified by year, gender, race/ethnicity, and geographic region. Results From 1999 to 2020, there were a total of 4,599,652 deaths attributed to acute kidney injury. The AAMR for acute kidney injury-related deaths surged from 11.4 in 1999 to 20.1 in 2020. Men consistently exhibited higher AAMRs than women throughout the study period (overall AAMR in men: 20.1; women: 13.2). When examining average AAMRs by race/ethnicity, Black/African Americans recorded the highest rates at 21.9, followed by American Indian or Alaskan Native (16.4), Whites (15.6), Hispanics (14.5), and Asian/Pacific Islander (10.7). Significant regional disparities were observed, with the southern region reporting the highest AAMR (17.2) and non-metropolitan areas having higher AAMRs than metropolitan areas (18.3 vs. 15.6). States in the top 90th percentile for acute kidney injury deaths included Indiana, Kentucky and South Carolina, which had nearly double the AAMR compared to states like New York, Utah, and Vermont. Conclusion In the last two decades, the United States has experienced a troubling increase in acute kidney injury-related deaths, emphasizing the urgent need for targeted and equitable healthcare interventions to address persistent disparities in gender, race, geography, and urbanization.

Ousley—Repatriation and the Smithsonian

The repatriation of Native American human remains has been a significant issue at the Smithsonian’s National Museum of Natural History for the past 40 years. Following the requirements of the National Museum of the American Indian Act of 1989, which mandated the use of the best available scientific and historical documentation to trace tribal origins, the Museum created the Repatriation Osteology Laboratory, which Stephen Ousley directed for the majority of his career at the Smithsonian. For nearly a decade, Ousley led exemplary osteological research in the service of repatriation, applying techniques of forensic anthropology, innovating craniometric and statistical analyses, and working collaboratively with the museum’s Native American partners. His high standards for the research and objective treatment of osteological evidence requiring critical thinking have served as a model for the Repatriation Office, students, and Native and non-Native researchers he worked with during his time at the Smithsonian and beyond.

Disparities in infectious disease-related health care utilization between Medicaid-enrolled American Indians and non-Hispanic Whites-Lessons from the first 16 months of coronavirus disease 2019 and a decade of flu seasons.

To understand why American Indian and Alaskan Native (AIAN) populations have had exceptionally high COVID-19 mortality, we compare patterns of healthcare utilization and outcomes for two serious infectious respiratory diseases-Influenza-like-illness (ILI) and coronavirus disease 2019 (COVID-19)-between American Indian and Alaskan Native (AIAN) populations (as identified in Medicaid data) and non-Hispanic Whites over the 2009-2021 period. We select all people under the age of 65 years identified as non-Hispanic White or AIAN in the New York State Medicaid claims data between 2009 and 2021. We analyze data across 10 ILI cohorts (between September 2009 and August 2020) and 4 COVID-19 cohorts (March-June 2020, July-September 2020, October-December 2020, and January-June 2021). We examine mortality and utilization rates using logistic regressions, adjusting for demographic characteristics, prior chronic conditions, and geographic location (including residence near a reservation). We stratify the analysis by rural vs. nonrural counties. We use the New York State Medicaid claims data for the analysis. We find that even among Medicaid beneficiaries, who are similar in socioeconomic status and identical in health insurance coverage, AIAN populations have much lower rates of use of outpatient services and much higher rates of acute (inpatient and emergency room) service utilization for both ILI and COVID-19 than non-Hispanic Whites. Prior to COVID-19, demographic and health status-adjusted all-cause mortality rates, including from ILI, were lower among American Indians than among non-Hispanic Whites on New York State Medicaid, but this pattern reversed during the COVID-19 pandemic. Both findings are driven by nonrural counties. We did not observe significant differences in all-cause mortality and acute service utilization comparing AIAN to non-Hispanic Whites in rural areas. The utilization and mortality disparities we identify within the Medicaid population highlight the need to move beyond insurance in addressing poor health outcomes in the American Indian population.

Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Supplemental Material for Diagnosable Mental Disorders Among American Indians and Alaska Natives in the United States: A Scoping Review

Supplemental Material for Diagnosable Mental Disorders Among American Indians and Alaska Natives in the United States: A Scoping Review

Experiences of Racism in School and Associations with Mental Health, Suicide Risk, and Substance Use Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Racism is a fundamental determinant of health inequities among racial and ethnic groups and is understudied among adolescents. In 2023, the national Youth Risk Behavior Survey questionnaire included an item assessing experiences of racism in the school setting among students in grades 9-12 in the United States. This report estimates the prevalence of students who reported ever having experienced racism in school and compares prevalence by racial and ethnic groups. For each racial and ethnic group, prevalence differences and prevalence ratios were estimated comparing the prevalence of indicators of poor mental health, suicide risk, and substance use among students who reported that they have ever versus never experienced racism in school. In 2023, approximately one in three high school students (31.5%) said that they had ever experienced racism in school. Reported experiences of racism were most prevalent among Asian (56.9%), multiracial (48.8%), and Black or African American (Black) (45.9%) students and least prevalent among White students (17.3%). Black and Hispanic or Latino (Hispanic) students who reported experiencing racism had a higher prevalence of all health risk behaviors and experiences investigated, including indicators of poor mental health, suicide risk, and substance use compared with students of their racial and ethnic group who reported never experiencing racism. Many of these associations were also found among multiracial and White students. Student reports of racism were associated with indicators of mental health and suicide risk among American Indian or Alaska Native (AI/AN) and Asian students. Among students of color, including AI/AN, Asian, Black, Hispanic, and multiracial students, the prevalence of seriously considering and attempting suicide was more than two times higher among students who ever compared with never experienced racism. These findings demonstrate that racism in the school setting is experienced by high school students attending public and private schools and continues to disproportionately affect students of color. Students who reported experiencing racism had a higher prevalence of indicators of poor mental health, suicide risk, and substance use. Schools can incorporate policies and practices to prevent unfair treatment on the basis of race and ethnicity and offer resources to help students cope with these experiences.

Report of Unfair Discipline at School and Associations with Health Risk Behaviors and Experiences - Youth Risk Behavior Survey, United States, 2023.

Relatively little is known about the association between school discipline and student health and well-being. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of report of unfair discipline at school and associations with experiences at school, mental health, suicidal thoughts and behaviors, and health risk behaviors among high school students overall and stratified by race and ethnicity. Prevalence estimates, prevalence differences, and prevalence ratios adjusted for race (in overall models), grade, and sex were calculated. Overall, 19.3% of students reported receiving unfair discipline during the previous 12 months; Black or African American students had a higher prevalence (23.1%) compared with Hispanic or Latino students (18.4%) and White students (18.1%). Unfair discipline was reported among a majority of students who describe their sexual identity in some other way (besides gay, heterosexual, lesbian, bisexual, or questioning) for American Indian or Alaska Native (81.7%) and multiracial (57.1%) subgroups. Overall, report of unfair discipline was associated with every health risk behavior and experience examined, including being bullied at school or electronically, skipping school due to feeling unsafe, carrying a weapon at school, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide. This pattern of association was similar among most student groups in models stratified by race and ethnicity. This analysis is the first to demonstrate, among a nationally representative sample of high school students, that reports of unfair discipline are associated with various health risk behaviors and experiences. With these findings, public health and education practitioners can create interventions that equitably promote safe, supportive, and inclusive school environments for student health.

Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2023.

The Youth Risk Behavior Surveillance System (YRBSS) is a set of surveys that tracks a broad range of behaviors, experiences, and conditions that can lead to poor health among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. For the 2023 national YRBS, CDC made changes to the sampling method, survey administration mode, and questionnaire. Specifically, the sampling design added an American Indian or Alaska Native (AI/AN) supplemental sample so that separate, precise estimates could be made for AI/AN high school students, in addition to the usual sample designed to provide nationally representative data for the population of students in grades 9-12. To decrease the time needed to collect and process data, CDC changed the survey administration mode from paper-and-pencil scannable booklets to a tablet-based electronic survey. To provide national data on topics of emerging interest, CDC added new questions to the questionnaire. These new questions assessed social media use, experiences of racism at school, adverse childhood experiences, transgender identity, consent for sexual contact, and unfair discipline at school. Public health practitioners and researchers can use YRBSS data to examine the prevalence of youth health behaviors, experiences, and conditions; monitor trends; and guide interventions. This overview report describes 2023 YRBSS survey methodology, including sampling, data collection, data processing, weighting, and data analyses. The 2023 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2023, in addition to the national YRBS, 68 site-level surveys were administered to high school students in 39 states, three tribal governments, five territories, and 21 local school districts. These site-level surveys use site-specific questionnaires that are similar to the national YRBS questionnaire but are modified to meet sites' needs. This overview and methods report is one of 11 featured in this MMWR supplement, which reports results from the 2023 national YRBS but does not include data from the 68 site-level surveys. Each report is based on data collected using methods presented in this overview report. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/yrbs/index.html).

Food Insecurity and Diabetes Insulin Adherence Among Older Adults

Older adults in the United States continue to be impacted by food insecurity. Diabetes is on the rise in older adults and insulin therapy is often recommended as treatment. However, less is known about the relationship between food insecurity and insulin adherence among older adults. The current study utilized secondary data analysis methods to examine the 2021 National Health Interview Survey to explore the relationship between food insecurity and insulin adherence among adults aged 55 and older who are living with diabetes. Results of multivariable logistic regression suggest that participants experiencing food insecurity were more likely to take less insulin than needed and delay buying insulin in the past 12 months compared to participants who were food secure. Homeownership was inversely associated with taking less insulin than needed. Higher income-to-poverty ratio was also inversely associated with skipping insulin doses, taking less insulin than needed, and delaying the purchase of insulin. Our results showed that other racialized/ethnic groups (i.e., American Indian, Alaskan Native, Asian, biracial, and multiracial persons) compared to White were less likely to skip an insulin dose and take less insulin than needed. Suggesting food insecurity should be considered when insulin therapy is recommended for older adults with diabetes.

Identifying Culturally Relevant School Support Profiles and Links to Academic Functioning in Adolescents.

There is limited knowledge about patterns of adolescents' experiences of general teacher support and support for critical consciousness and cultural competence development in school settings, which are key experiences proposed to promote academic functioning. Furthermore, less is known about potential developmental and ethnic-racial differences in these patterns. Using a person-centered approach, this study examined culturally relevant school support profiles in a sample of sixth and ninth grade students (N = 717; 49.9% girls) from the U.S. Southwest. Participants were aged 10 to 18 years (M = 13.73; SD = 1.54) and were ethnoracially diverse (31.8% Hispanic/Latinx, 31.5% Multiethnic, 25.7% White, 7.3% Black or African American, 1.4% Asian American or Pacific Islander, 1.4% American Indian or Alaska Native, and 1% Arab, Middle Eastern, or North African). Four culturally relevant school support profiles were identified: (1) low general, devoid cultural & critical support; (2) moderate general, moderate cultural, & devoid critical support; (3) high general, moderate cultural & critical support; and (4) high general, cultural, & critical support. Youth in the high general, cultural, & critical support profile had higher concurrent emotional and behavioral engagement. No significant differences were found between early (6th grade) and middle adolescent (9th grade) youth, pointing to the relevance and associations of the identified profiles across development. One significant difference emerged when comparing White and ethnoracially minoritized youth; among White youth, those in the high general, cultural, & critical support and high general, moderate cultural & critical support profiles had higher academic expectations than those in the low general, devoid cultural & critical support profile. The discussion focuses on characterizing heterogeneous and culturally relevant school support profiles, the associations between these profiles and indicators of academic functioning for ethnoracially diverse youth to advance developmental theory and the importance of promoting culturally relevant school support practices to foster developmental competencies among youth.