American Indian/Alaska Native Research Articles

Our Collective Needs and Strengths: Urban AI/ANs and the COVID-19 Pandemic.

The COVID-19 pandemic has raised national consciousness about health inequities that disproportionately impact American Indian/Alaska Native (AI/AN) communities, yet urban AI/AN communities continue to remain a blind spot for health leaders and policymakers. While all United States cities have been the traditional homelands of AI/AN peoples since time immemorial, urban AI/ANs are consistently excluded in local and national health assessments, including recent reports pertaining to COVID-19. Today the majority of AI/ANs (71%) live in urban areas, and many cities have strong Urban Indian Health Programs (UIHPs) that provide space for medical care, community gatherings, cultural activities, and traditional healing. Many of these UIHPs are currently scrambling to meet the needs of their AI/AN service communities during the pandemic. While the COVID-19 pandemic brought new sources of funding to UIHPs, the lack of local AI/AN data and arbitrary funding restrictions precluded some UIHPs from addressing their communities’ most immediate challenges such as food and economic insecurities. Despite these challenges, urban AI/AN communities carry the historical resilience of their ancestors as they weave strong community networks, establish contemporary traditions, and innovate to meet community needs. This article focuses on the experiences of one UIHP in Baltimore City during the COVID-19 pandemic to illustrate present-day challenges and strengths, as well as illuminate the urgency for tailored, local data-driven public health approaches to urban AI/AN health.

Demographic Characteristics of Persons Vaccinated During the First Month of the COVID-19 Vaccination Program - United States, December 14, 2020-January 14, 2021.

In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for emergency use in the United States for the prevention of coronavirus disease 2019 (COVID-19).* Because of limited initial vaccine supply, the Advisory Committee on Immunization Practices (ACIP) prioritized vaccination of health care personnel† and residents and staff members of long-term care facilities (LTCF) during the first phase of the U.S. COVID-19 vaccination program (1). Both vaccines require 2 doses to complete the series. Data on vaccines administered during December 14, 2020-January 14, 2021, and reported to CDC by January 26, 2021, were analyzed to describe demographic characteristics, including sex, age, and race/ethnicity, of persons who received ≥1 dose of COVID-19 vaccine (i.e., initiated vaccination). During this period, 12,928,749 persons in the United States in 64 jurisdictions and five federal entities§ initiated COVID-19 vaccination. Data on sex were reported for 97.0%, age for 99.9%, and race/ethnicity for 51.9% of vaccine recipients. Among persons who received the first vaccine dose and had reported demographic data, 63.0% were women, 55.0% were aged ≥50 years, and 60.4% were non-Hispanic White (White). More complete reporting of race and ethnicity data at the provider and jurisdictional levels is critical to ensure rapid detection of and response to potential disparities in COVID-19 vaccination. As the U.S. COVID-19 vaccination program expands, public health officials should ensure that vaccine is administered efficiently and equitably within each successive vaccination priority category, especially among those at highest risk for infection and severe adverse health outcomes, many of whom are non-Hispanic Black (Black), non-Hispanic American Indian/Alaska Native (AI/AN), and Hispanic persons (2,3).

Alcohol policy effects on 100% chronic alcohol-attributable mortality across racial/ethnic subgroups

In the United States, some racial/ethnic minorities suffer from higher rates of chronic alcohol problems, and alcohol-related morbidity and mortality than Whites. Furthermore, state-level alcohol policies may affect racial/ethnic subgroups differentially. We investigate effects of beverage-specific taxes and government control of spirits retail on alcohol-related mortality among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic American Indians/Alaska Natives (AI/AN) and Hispanics using death certificate and state-level alcohol policy data for 1999–2016. Outcomes were analyzed as mortality rates (per 10,000) from 100% alcohol-attributable chronic conditions (“100% chronic AAD”). Statistical models regressed racial/ethnic-specific logged mortality rates on state-level, one-year lagged and logged beer tax, one-year lagged and logged spirits tax, and one-year lagged government-controlled spirits sales, adjusted for mortality trends, fixed effects for state, and clustering of standard errors. Government control was significantly (P < 0.05) related to 3% reductions in Overall and non-Hispanic White mortality rates, and 4% reductions in Hispanic mortality rates from 100% chronic AAD. Tax associations were not robust. Results support that government control of spirits retail is associated with significantly lower 100% AAD from chronic causes Overall and among non-Hispanic Whites and Hispanics. Government control of spirits retail may reduce both population-level 100% chronic AAD as well as racial/ethnic disparities in 100% chronic AAD.

Trauma injury, severity, and outcomes among pediatric American Indian/Alaska Natives in the North Central United States

BackgroundThere is a disproportionately higher trauma morbidity between American Indian/Alaska Native (AI/AN) and non-AI/AN children. ObjectiveTo characterize and compare trauma in AI/AN and non-AI/AN children presenting to a Regional Pediatric Level II Trauma Center (Adult Level I Trauma Center). MethodA retrospective observational study of all children <20 years presenting from 2012–2018. Descriptive data were analyzed along with T-tests to determine if demographic and clinical characteristics were different for AI/AN and non-AI/AN children. ResultsAI/AN children are more likely to be referred from outside hospitals [OR 5.61, 95% CI 3.79, 8.29], to have penetrating injuries [OR 3.87, 95% CI 1.88, 7.99] and have higher likelihood of both minor [OR 1.48, 95% Cl 1.06, 2.07] and major [OR 1.99, 95% Cl 1.37, 2.87] trauma activation on arrival. More AI/AN children suffer violent injuries [OR 3.12, 95% CI 1.90, 5.01], utilized Intensive Care Unit (ICU) [OR 1.54 95% CI 1.10, 2.14], had prolonged length of stay (LOS) [OR 1.52, 95% Cl 1.28, 1.80], and were less likely discharged home [OR 0.65, 95% Cl 0.44, 0.96]. ConclusionsAI/AN pediatric trauma patients suffer higher morbidity compared to non-AI/AN pediatric trauma patients. This study provides data which supports the need for future interventions to decrease the burden of injury noted among AI/AN children. Study TypeTreatment Study Type and Level of EvidenceRetrospective comparative study; Level III

Challenging Assumptions About Race/Ethnicity, Socioeconomic Status, and Cigarette Smoking Among Adolescents.

Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents. Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted. Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions. The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

Data Disaggregation with American Indian/Alaska Native Population Data

More than any other racial group, American Indian/Alaska Natives (AIAN) face the risk of imprecise survey estimates due to survey processes regarding the classification, tabulation, and weighting of race/ethnicity. Variations in approaches to classifying racial and ethnic populations in federal and state health statistics have substantial implications for how we measure health status, access to healthcare, healthcare quality, and health equity. We identify strategies to improve data capacity for AIAN in federal health surveys by exploring current approaches to collecting and coding of AIANs across eight population-based health surveys (seven federal surveys and the California Health Interview Survey). Our analysis assesses how different coding and weighting decisions affect the classification and measurement of the AIAN population by comparing single-race non-Hispanic/Latino AIAN to more expansive classifications that include not only those reporting AIAN race alone, but also individuals reporting AIAN race in combination with other races and/or in combination with Hispanic/Latino ethnicity. Our results provide insight into the representativeness of each survey on the AIAN population and our ability to draw conclusions about the health of the AIAN population and the health disparities they face. The results show considerable variation across surveys in their measurement of the AIAN population based on survey classification, tabulation, and weighting approaches.

Extending Research Protections to Tribal Communities

The history of research in American Indian/Alaska Native (AI/AN) communities has been marked by unethical practices, resulting in mistrust and reluctance to participate in research. Harms are not limited to individual persons—tribal communities experience harmful misrepresentation and generalizations disrespectful of AI/AN groups’ heritage, cultures, and beliefs. The Belmont Report’s research ethics principles are applied primarily to protect individual research participants. The principles of sovereignty and solidarity are argued to be important concepts in extending Belmont’s research protections to tribal communities. Sovereignty, an expression of respect for autonomy at a group level, is the basis for tribal self-determination. The principle of solidarity provides an ethical underpinning for tribes’ obligations to protect community interests and culture. Extension of Belmont through these principles should serve to minimize harms to AI/AN groups in research.

Findings Associated With a Novel Program Designed to Support Indigenous Faculty Members of U.S. Health Professions Schools

&#x0D; &#x0D; &#x0D; Purpose: Recent studies on programs designed to support Indigenous faculty are lacking. Expanding numbers of successful Indigenous health faculty could help to improve delivery of culturally appropriate/responsive health care for Indigenous people. Methods: We enrolled nine American Indian/Alaska Native (AIAN) faculty participants in 2017 and 53 in 2018 in an Indigenous Faculty Forum (IFF). We provided instruction on academic advancement, addressed unique cultural considerations, and fostered networking and ongoing career support for AIAN faculty. We used a post-session survey, including the 22-item Diversity and Engagement Survey (DES) and focus groups, to assess initial reactions to the program and a follow-up survey to assess change at 1 year. Findings: Participants in both IFF sessions were predominantly female, most often aged 35–44 and from primary care disciplines. Two faculty members rose to a higher rank during the 1-year follow-up period. Findings from the DES illustrated that Common Purpose, Equitable Reward and Recognition, Cultural Competence, Trust, a Sense of Belonging, and Appreciation of Individual Attributes increased slightly from post-session to 1 year. The greatest change was for Respect, which increased from a mean of 3.42 (SD = 0.77) to 3.76 (SD = 0.67), p = .05. Focus group findings revealed that mentoring that includes the cultural perspectives of AIAN is lacking, as is respect for these faculty from the academic community, though survey findings showed respect improved over time. Conclusions: More tailored work is needed to support AIAN in U.S. academic settings if they are to achieve academic success and become role models for others entering academic settings.&#x0D; &#x0D; &#x0D;

Racial/Ethnic Differences in Preceding Circumstances of Suicide and Potential Suicide Misclassification Among US Adolescents.

There is a paucity of research on racial/ethnic differences in preceding circumstances of suicide among adolescents aged 10-19years and consequential potential misclassification of suicide deaths (i.e., manner of death classified as injury of undetermined intent). This study (1) examined preceding circumstances of suicide among non-Hispanic White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander (A/PI), non-Hispanic American Indian/Alaskan Native (AI/AN), and Hispanic adolescent decedents; and (2) investigated potential suicide misclassification of racial/ethnic minority decedents. We used data from the 2006-2015 National Violent Death Reporting System Restricted Access Database. Multivariable logistic regression analyses examined differences in depressed mood, mental health problem and treatment, crisis in the past 2weeks, problems with school, intimate partner, family relationship, and other relationships (e.g., friend) among racial/ethnic minority decedents compared to White decedents. A separate logistic regression analysis assessed potential suicide misclassification of racial/ethnic minority decedents relative to White counterparts. Adjusting for sex and suicide history and circumstances, all racial/ethnic minority decedents had significantly lower odds of documented mental health problem and treatment compared to White decedents. Racial/ethnic differences in relationship problems were also identified. Black decedents had significantly higher odds of manner-of-death classification as undetermined intent than did White decedents, suggesting greater likelihood of suicide misclassification. Circumstances contributing to suicide among adolescents differ by race/ethnicity, indicating the need for culturally tailored suicideprevention efforts.

Influence of Race/Ethnicity on Cesarean Delivery by Year in the United States

Objective: Attempts have been made to reduce the rate of cesarean delivery in the United States. The intent of this study was to examine the trends of cesarean delivery rates over time by race/ethnicity in the United States, stratified by parity and history of prior cesarean delivery. Methods: A retrospective cohort study in the United States between 2011 and 2018 using linked vital statistics data derived from National Center for Health Statistics. Race/ethnicity was categorized into non-Hispanic white, non-Hispanic Black, Hispanic, Asian, and American Indian & Alaska Native (AIAN). Chi-square tests were used to compare rates of cesarean delivery between years among all racial/ethnic groups. Multivariable logistic regression analyses were used to examine the association of race/ethnicity with cesarean delivery, controlling for maternal age, BMI, parity, education, number of prenatal visits, insurance, diabetic disease and hypertensive disease. Our main outcomes were rates of cesarean delivery in each considered racial/ethnic group and year by parity and history of prior cesarean delivery. Results: Our cohort of 27,779,284 patients consisted of 14,982,866 (53.9%) white, 4,046,238 (14.6%) Black, 6,750,058 (24.3%) Hispanic, 1,773,798 (6.4%) Asian, and 226,324 (0.8%) AIAN individuals. When examining nulliparous parturients, the rates of cesarean delivery decreased for white, Asian, and AIAN nulliparas, but increased from 33.1% to 33.5% (p=0.01) for Black nulliparas between the years of 2011 to 2018. The rates of cesarean delivery in multiparous individuals decreased across all racial/ethnic groups. Conclusion: Rates of cesarean delivery increased in Black individuals but decreased in all other races/ethnicities over time among nulliparas. During a time when efforts were made to reduce the risk of cesarean delivery, rates both increased in Black individuals and health disparities increased. As these associations persisted even when controlling for confounders in multivariate analysis, investigation of structural contributors of these varied outcomes is needed. Funding: None to declare. Declaration of Interest: None to declare.

Belief in the American Indian/Alaska Native biological vulnerability myth and drinking to cope: Does stereotype threat play a role?

Objectives: The effects of stereotype threat and internalized alcohol stereotypes on negative affect and negative affect-related drinking have not been examined in American Indians/Alaska Natives (AI/ANs), despite their frequently being subjected to alcohol stereotypes. The current study examined the association of belief in the myth of an AI/AN specific biological vulnerability (BV) with alcohol consequences through its effect on depression and drinking to cope with negative affect. Method: In this cross-sectional study, a moderated mediation model examined the association of belief in a BV with alcohol consequences via sequential mediators of depression and drinking to cope. It was hypothesized that the positive association of belief in a BV with depression would be stronger among individuals who engaged in more frequent heavy episodic drinking. Participants were 109 female (69.9%) and 47 male (30.1%) AI/AN college students (Mage = 27.1 years, range 18 to 61) who reported having at least 1 drink in the past month. Results: Belief in a BV was positively associated with depression symptoms among participants reporting average or high frequency of heavy episodic drinking. Greater depression symptoms predicted greater drinking to cope, which in turn predicted greater alcohol consequences. Conclusion: Belief in the BV myth may act as a type of stereotype threat, contributing to alcohol consequences by increasing negative affect and drinking to cope. These results suggest that for AI/ANs who drink, there are psychological and behavioral health ramifications of believing in the notion of a BV, and a need to debunk this myth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Relationship of Self-Compassion and Suicide Risk Factors in American Indian/Alaska Native People.

In this study, positive aspects of self-compassion (i.e., self-kindness, common humanity, and mindfulness of one's thoughts and feelings) were explored in relation with suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) in a community sample of 242 self-identified American Indian/Alaska Native (AI/AN) adults. Participants completed a survey packet including a demographic form, the Interpersonal Needs Questionnaire, and the Self-Compassion Scale at several Indian Health Service clinics and tribal centers in the Great Plains of the United States. Results indicated that positive aspects of self-compassion (i.e., self-kindness, common humanity, and mindfulness) were associated with and predictive of less suicide risk (i.e., less perceived burdensomeness and thwarted belongingness) among AI/AN adults. Of those with a history of suicidal ideation (n = 89), positive aspects of self-compassion were predictive of less perceived burdensomeness, but were not predictive of thwarted belongingness. Implications for prevention and intervention programs that emphasize self-compassion, mindfulness, and culturally relevant practices, as well as mental health advocacy, including suicide prevention, for AI/AN people are highlighted.

Recommendations to researchers for aiding in increasing American Indian representation in genetic research and personalized medicine.

Increasing American Indian/Alaska Native (AI/AN) representation in genetic research is critical to ensuring that personalized medicine discoveries do not widen AI/AN health disparities by only benefiting well-represented populations. One reason for the under-representation of AIs/ANs in research is warranted research distrust due to abuse of some AI/AN communities in research. An approach to easing the tension between protecting AI/AN communities and increasing the representation of AI/AN persons in genetic research is community-based participatory research. This approach was used in a collaboration between a tribe and academic researchers in efforts to increase AI/AN participation in genetic research. From the lessons learned, the authors propose recommendations to researchers that may aid in conducting collaborative and respectful research with AI/AN tribes/communities and ultimately assist in increasing representation of AIs/ANs in personalized medicine discoveries.

Characteristics and competencies of successful resource parents working in Indian country: A systematic review of the research

Despite the implementation of the Indian Child Welfare Act over the last 40 years, American Indian/Alaska Native (AIAN) children continue to be removed from their homes at an alarming rate and are overrepresented across the United States’ foster care system. To ensure the future of tribal communities, it is imperative that AIAN children grow up connected to their culture and their identity. One method to ensure stability is to increase efforts to recruit and retain competent, committed tribal relatives as caretakers, and when not possible, AIAN resource parents who are ready and able to care for them. This study utilized PRISMA methodology to conduct a systematic review to identify characteristics and competencies of successful resource parents who care for AIAN children and youth. Four major characteristics (strong cultural identity, resilient and adaptive to change, willingness to access tribal resources, and willingness to access kin/family as resources) and five major competencies (history, laws and policy; health and wellness from the AIAN perspective, AIAN family, kinship and community structure, and AIAN learning style, pedagogy and methods) were identified. Implications for policy and practice are discussed.

COVID-19 Mortality Among American Indian and Alaska Native Persons - 14 States, January-June 2020.

American Indian/Alaska Native (AI/AN) persons experienced disproportionate mortality during the 2009 influenza A(H1N1) pandemic (1,2). Concerns of a similar trend during the coronavirus disease 2019 (COVID-19) pandemic led to the formation of a workgroup* to assess the prevalence of COVID-19 deaths in the AI/AN population. As of December 2, 2020, CDC has reported 2,689 COVID-19-associated deaths among non-Hispanic AI/AN persons in the United States.† A recent analysis found that the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN persons was 3.5 times that among White persons (3). Among 14 participating states, the age-adjusted AI/AN COVID-19 mortality rate (55.8 deaths per 100,000; 95% confidence interval [CI] =52.5-59.3) was 1.8 (95% CI =1.7-2.0) times that among White persons (30.3 deaths per 100,000; 95% CI =29.9-30.7). Although COVID-19 mortality rates increased with age among both AI/AN and White persons, the disparity was largest among those aged 20-49 years. Among persons aged 20-29 years, 30-39 years, and 40-49 years, the COVID-19 mortality rates among AI/AN were 10.5, 11.6, and 8.2 times, respectively, those among White persons. Evidence that AI/AN communities might be at increased risk for COVID-19 illness and death demonstrates the importance of documenting and understanding the reasons for these disparities while developing collaborative approaches with federal, state, municipal, and tribal agencies to minimize the impact of COVID-19 on AI/AN communities. Together, public health partners can plan for medical countermeasures and prevention activities for AI/AN communities.

Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention: Lessons Learned from the BRAVE Study.

This paper shares lessons learned recruiting and engaging participants in the BRAVE study, a randomized controlled trial carried out by the Northwest Portland Area Indian Health Board and the mHealth Impact Lab. The team recruited 2330 American Indian/Alaska Native (AI/AN) teens and young adults nationwide (15–24 years old) via social media channels and text message and enrolled 1030 to participate in the 9 month study. Teens and young adults who enrolled in this study received either: 8 weeks of BRAVE text messages designed to improve mental health, help-seeking skills, and promote cultural pride and resilience; or 8 weeks of Science Technology Engineering and Math (STEM) text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine; and then received the other set of messages. Results indicate that social media channels like Facebook and Instagram can be used to recruit AI/AN teens and young adults. Retention in this study was high, with 87% of participants completing both the BRAVE and STEM intervention arms. Lessons learned from this process may help teen and young adult-serving organizations, prevention programs, policy makers, researchers, and educators as they support the next generation of AI/AN change makers.

Abstract PO-165: Renal cell carcinoma health disparities in American Indians/Alaska Natives and Hispanic Americans

Abstract Background: American Indians/Alaska Natives (AIs/ANs) and United States (U.S.)- born Hispanic Americans (HAs) have higher kidney cancer mortality rates compared to non-Hispanic Whites (NHWs). However, causes for the disparities have not been well understood. The aim of our study was to assess if socioeconomic factors and residence pattern (urban vs. rural) account for renal cell carcinoma (RCC) health disparities in AIs/ANs and HAs focusing on advanced stage (stage III/IV) diagnosis and survival. Methods: RCC patients diagnosed between 2004 and 2015 (n=405, 073) in National Cancer Database (NCDB) and between 2007 and 2016 (n=9,982) in Arizona Cancer Registry (ACR) were analyzed. Logistic regression and Cox regression analysis were performed to ascertain the effect of race/ethnicity on stage at diagnosis and overall survival adjusting for patient’s characteristics, including census tract socioeconomic status (SES), Rural-Urban Continuum Codes (RUCC), and other relevant factors. High school graduate rate, median income (or poverty rate), and unemployment rate was used to measure socioeconomic status. In ACR data, sub- distribution Cox proportional hazards regression was performed to study time to death due to RCC accounting for competing risks. Results: There were a total of 405,073 cases in NCDB and 9,982 cases in ACR. In both NCDB and ACR data, AIs/ANs had significantly increased odds of having advanced stage at diagnosis in unadjusted model (OR 1.20, 95% CI: 1.08-1.33 and OR 1.29, 95% CI: 1.06-1.56 respectively in NCDB and ACR), but the association was not significant after adjusting for patient’s characteristics. In both datasets, Mexican Americans had higher odds of having advanced stage diagnosis compared to NHWs (OR 1.22, 95% CI: 1.11-1.35 and OR 2.02, 95% CI: 1.58-2.58 respectively) even after adjusting for patient’s characteristics, including SES and RUCC. In ACR, advanced stage diagnosis was particularly common in U.S.-born Mexican Americans (49.1%) compared to NHWs (26.4%). AIs/ANs showed increased mortality risk in unadjusted model in both datasets (HR 1.10, 95% CI:1.01-1.20 and HR 1.20, 95% CI: 1.05-1.37 respectively in NCDB and ACR). The association was no longer significant in NCDB after adjusting for patient’s characteristics, while it remained significant in ACR (HR 1.33, 95% CI: 1.03-1.72). In Arizona, Mexican Americans had significantly higher risk of mortality compared to NHWs in both unadjusted and adjusted models (HR 2.46, 95% CI: 2.23-2.72 and HR 2.34, 95% CI: 1.93-2.90). The greatest risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans (HR 3.21, 95% CI: 2.61-3.98 and sub- distribution HR 2.79, 95% CI: 2.05-3.81). Conclusion: RCC disparities in AIs/ANs is partially explained by neighborhood socioeconomic and residence characteristics, but the neighborhood characteristics did not affect the associations for HAs. Greater RCC health disparities were observed among Mexican Americans in Arizona than the national level. Citation Format: Celina I. Valencia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee, Ken Batai. Renal cell carcinoma health disparities in American Indians/Alaska Natives and Hispanic Americans [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-165.

Racial/Ethnic Representation in United States and Australian Obstetric Research.

To describe racial/ethnic representation in United States (US) and Australian obstetric research, represented by the Maternal-Fetal Medicine Units Network (MFMU) and Australian Research Centre for Health of Women and Babies (ARCH) trials. MFMU studies were identified through PubMed and ARCH studies through their online publication listing from 2011 to 2016. Observational and randomized cohorts and primary and secondary data analyses were included. Studies with race-based enrollment were excluded. Racial/ethnic representation was expressed as the mean racial/ethnic percentages of the studies (i.e.,: studies weighted equally regardless of sample size). Racial/ethnic percentages in MFMU studies were compared to US registered births and ARCH compared to Australian census ancestry data. 38 MFMU studies included 580,282 women. Racial/ethnic representation (% [SD]) included White 41.7 [12.3], Hispanic 28.1 [15.4], Black 26.2 [12.3], Asian 3.6 [2.3], and American Indian/Alaskan Native (AI/AN) 0.2 [0.02]. No studies reported Native Hawaiian/other Pacific Islanders (NHOPI) separately. Comparatively, registered US births (%) were White 75.7, Hispanic 28.1, Black 16.1, Asian/Pacific Islander 7.1, and AI/AN 1.1, which differed from the MFMU (P = 0.02). 20 ARCH studies included 51,873 women. The most reported groups were White 76.5 [17.4], Asian 15.2 [14.8], and Aboriginal/Torres Strait Islander 13.9 [30.5], compared to census numbers of White 88.7, Asian 9.4, and Aboriginal/Torres Strait Islander 2.8 (P < 0.01). Two ARCH studies reported African ethnicity. There is racial diversity in studies by MFMU and ARCH, with opportunities to increase enrollment and enhanced reporting of Asian, AI/AN, and NHOPI races in MFMU studies and Black race in ARCH studies.

Tobacco Product Use Among Adults - United States, 2019.

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). The prevalence of current cigarette smoking among U.S. adults has declined over the past several decades, with a prevalence of 13.7% in 2018 (2). However, a variety of combustible, noncombustible, and electronic tobacco products are available in the United States (1,3). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC analyzed data from the 2019 National Health Interview Survey (NHIS). In 2019, an estimated 50.6 million U.S. adults (20.8%) reported currently using any tobacco product, including cigarettes (14.0%), e-cigarettes (4.5%), cigars (3.6%), smokeless tobacco (2.4%), and pipes* (1.0%).† Most current tobacco product users (80.5%) reported using combustible products (cigarettes, cigars, or pipes), and 18.6% reported using two or more tobacco products.§ The prevalence of any current tobacco product use was higher among males; adults aged ≤65 years; non-Hispanic American Indian/Alaska Native (AI/AN) adults; those whose highest level of educational attainment was a General Educational Development (GED) certificate; those with an annual household income <$35,000; lesbian, gay, or bisexual (LGB) adults; uninsured adults and those with Medicaid; those with a disability; or those with mild, moderate, or severe generalized anxiety disorder. E-cigarette use was highest among adults aged 18-24 years (9.3%), with over half (56.0%) of these young adults reporting that they had never smoked cigarettes. Implementing comprehensive, evidence-based, population level interventions (e.g., tobacco price increases, comprehensive smoke-free policies, high-impact antitobacco media campaigns, and barrier-free cessation coverage), in coordination with regulation of the manufacturing, marketing, and sale of all tobacco products, can reduce tobacco-related disease and death in the United States (1,4). As part of a comprehensive approach, targeted interventions are also warranted to reach subpopulations with the highest prevalence of use, which might vary by tobacco product type.

Maternal Mortality Among American Indian/Alaska Native Women: A Scoping Review.

Background: Maternal mortality decreased globally by about 38% between 2000 and 2017, yet, it continues to climb in the United States. Gaping disparities exist in U.S. maternal mortality between white (referent group) and minority women. Despite important and appropriate attention to disparities for black women, almost no attention has been given to American Indian/Alaska Native (AI/AN) women. The purpose of this scoping review is to synthesize available literature concerning AI/AN maternal mortality. Methods: Databases were searched using the terms maternal mortality and pregnancy-related death, each paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria (e.g., hemorrhage) were paired with initial search terms. Next, pregnancy-associated death was paired with American Indian, Native American, Alaska Native, Inuit, and Indigenous. Criteria in this category were homicide, suicide, and substance use. Results: The three leading causes of AI/AN pregnancy-related maternal mortality are hemorrhage, cardiomyopathies, and hypertensive disorders of pregnancy. AI/AN maternal mortality data for homicide and suicide consistently include small samples and often categorize AI/AN maternal deaths in an "Other" race/ethnicity, which precludes targeted AI/AN data analysis. No studies that reported AI/AN maternal mortality as a result of substance use were found. Health care characteristics such as quality, access, and location also may influence maternal outcomes and maternal mortality. Conclusions: Despite AI/AN maternal mortality being disproportionately high compared to other racial/ethnic groups, relatively little is known about root causes.