Among American Indian/Alaska Native Research Articles

Telomere length and cognitive function among middle-aged and older participants from communities underrepresented in aging research: A preliminary study.

Accelerated biological aging is a plausible and modifiable determinant of dementia burden facing minoritized communities, but is not well-studied in these historically underrepresented populations. Our objective was to preliminarily characterize relationships between telomere length and cognitive health among American Indian/Alaska Native (AI/AN) and Black/African American (B/AA) middle-aged and older adults. This study included data on telomere length and cognitive test performance from 187 participants, enrolled in one of two community-based cognitive aging cohorts and who identified their primary race as AI/AN or B/AA. Nested multivariable regression models revealed preliminary evidence for associations between telomere length and cognitive performance, and these associations were partially independent of chronological age. Small sample size limited estimate precision, however, findings suggest future work on telomere length and cognitive health in underrepresented populations at high risk for dementia is feasible and valuable as a foundation for social and behavioral intervention research.

Homicides of American Indians/Alaska Natives in urban versus rural areas: United States National Violent Death Reporting System, 2003–2020

BackgroundMissing and Murdered Indigenous People is a historic and contemporary issue that has gained national attention. In 2021, homicide was the eighth leading cause of death among American Indian/Alaska Native...

Evaluating Two Educational Interventions for Enhancing COVID-19 Knowledge and Attitudes in a Sample American Indian/Alaska Native Population.

The COVID-19 pandemic has exacerbated existing healthcare disparities among American Indian/Alaska Native (AI/AN) populations rooted in historical traumas and systemic marginalization. This study conducted at a single Indian Health Service (IHS) clinic in central Michigan evaluates two educational interventions for enhancing COVID-19 knowledge and attitudes in a sample AI/AN population. Utilizing a pre/post-intervention prospective study design, participants received either a video or infographic educational intervention, followed by a survey assessing their COVID-19 knowledge and attitudes. The results indicate significant improvements in knowledge and attitudes post-intervention, with both modalities proving effective. However, specific factors such as gender, political affiliation, and place of residence influenced COVID-19 attitudes and knowledge, emphasizing the importance of tailored interventions. Despite limitations, this study highlights the critical role of educational interventions in addressing vaccine hesitancy and promoting health equity within AI/AN communities. Moving forward, comprehensive strategies involving increased Indian Health Service funding, culturally relevant interventions, and policy advocacy are crucial in mitigating healthcare disparities and promoting health equity within AI/AN communities.

Abstract 4872: Elevated colorectal cancer incidence among American Indian/Alaska Native persons in Alaska compared to other populations worldwide

Abstract Background: Colorectal cancer (CRC) is a leading cancer worldwide. Incidence varies greatly by country and racial group. We present recent CRC incidence and mortality rates among American Indian/Alaska Native (AI/AN) persons in Alaska and compare them to rates among other racial groups in Alaska and AI/AN persons in other regions of the United States, and to published CRC incidence rate estimates for other countries around the world. Methods: To calculate CRC incidence in the United States, we used U.S. Cancer Statistics data, which includes cancer registry data from the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Cancer data for AI/AN persons in Alaska came from the Alaska Cancer Registry as well as the Alaska Native Tumor Registry. Death data came from the CDC’s National Death Index, which was linked with the Indian Health Service patient registry database to address race misclassification in AI/AN populations, to create the United States Cancer Statistics American Indian and Alaska Native Mortality Database. This database was used to calculate CRC mortality rates for AI/AN persons in this study. Rates were age-adjusted using the World Health Organization’s World Standard Population (2000-2025), so that rates for AI/AN persons in the United States could be more comparable to rates that have been estimated for countries around the world. Estimates of worldwide CRC incidence came from the International Agency for Research on Cancer Global Cancer Observatory GLOBOCAN 2020 database. Results: AI/AN persons in Alaska (males and females combined) had the highest CRC incidence rate (58.4 per 100,000 people) in the year 2020, when compared to AI/AN persons in every other region of the United States. Within Alaska, AI/AN persons had a higher CRC incidence rate than persons of any other racial group. When compared with published CRC incidence rates worldwide, the rate for AI/AN persons in Alaska was higher than the rates reported for any country in the world in 2020. The country with the highest recorded CRC incidence rate in 2020 was Hungary (45.3 per 100,000 people). AI/AN persons in Alaska also had the highest CRC mortality rate (27.1 per 100,000 people) in 2020. Worldwide, the country with the highest recorded CRC mortality rate in 2020 was Slovakia (21.0 per 100,000 people). Conclusions: This review of CRC incidence and mortality rates from populations in the US and worldwide showed that AI/AN persons in Alaska had the highest documented incidence and mortality rates of CRC in the world in 2020. Health systems serving AI/AN persons in Alaska could implement policies and interventions that support colorectal cancer screening, to reduce the burden of this preventable disease. Citation Format: Donald Haverkamp, Diana Redwood, Elena Roik, Stephen Vindigni. Elevated colorectal cancer incidence among American Indian/Alaska Native persons in Alaska compared to other populations worldwide [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 4872.

Trends in Fatal Opioid-Related Overdose in American Indian and Alaska Native Communities, 1999–2021

IntroductionOpioid-related overdose (OOD) mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. OOD trends among American Indian/Alaska Native (AI/AN) require further quantification and assessment. MethodsObservational, U.S. population-based registry data on OOD mortality between 1999-2021 were extracted in 2023 using ICD-10 codes from the CDC WONDER multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate OOD mortality growth rates among AI/AN population between 1999-2021. Analyses were performed in 2023. ResultsTwo distinct time segments revealed significantly different OOD mortality growth rates within the overall AI/AN population, from 0.36 per 100,000 (95% CI: 0.32, 0.41) between 1999 and 2019, to 6.5 (5.7, 7.31) between 2019-2021, with the most pronounced increase among those of 24 to 44 years old. Similar patterns were observed within the AI/AN population with Hispanic ethnicity, but the estimated growth rates were generally steeper across most age groups compared to the overall AI/AN population. Patterns of OOD mortality growth rates were similar between AI/AN females and males between 2019-2021. ConclusionsSharp increases in OOD mortality rates among AI/AN communities are evident by age and Hispanic ethnicity, highlighting the need for culturally-sensitive fatal OOD prevention, opioid use disorder treatment, and harm reduction efforts. Future research should aim to understand the underlying factors contributing to these high mortality rates and employ interventions that leverage the strengths of AI/AN culture, including the strong sense of community.

The Role of Social Networks on Depression and Anxiety Among a Sample of Urban American Indian/Alaska Native Emerging Adults

PurposeMental health inequalities continue to persist among American Indian/Alaska Native (AI/AN) people. However, few studies have examined the association of social networks and depression and anxiety among urban emerging AI/AN adults. MethodsThis study analyzes the association of social network characteristics with depression and anxiety among a sample of urban AI/AN emerging adults. A second set of regression models tested the same associations but controlling for respondent sexual and gender minority (SGM) status. Data were from a sample of 150 AI/AN emerging adults residing in urban areas from 20 different states (86% female; mean age 21.8; 48.0% SGM) who participated in a randomized controlled trial analyzing the effects of culturally grounded interventions on alcohol and other drug use and cultural connectedness. ResultsParticipants with a higher proportion of network members who were around the same age reported significantly less anxiety. Those who had a higher proportion of network members who they sometimes/often argue/fight with were more likely to report greater depression and anxiety. Participants with higher proportions of social network members who have ever lived on a reservation/Rancheria/tribal land/tribal village reported significantly less depression. However, participants with higher proportions of social network members who lived 50 miles away or more reported significantly more depression. Controlling for SGM status, results were largely similar. DiscussionResults highlight the role of social connections on the mental well-being of urban AI/AN emerging adults.

Association between steroid use and concussions among high school athletes: a cross-sectional analysis of the Youth Risk Behavior Surveillance System.

In 2017, there were almost 2.5 million high school students who experienced a concussion while playing a sport, raising concern for the neurologic problems that theycould face. Some of these athletes may seek to gain a competitive advantage in their sport by utilizing substances like steroids. However, steroid use can cause increased aggression and body mass index (BMI), which might lead to heightened risk for concussions. Despite extensive research, we found no previous evidence linking these two factors. This analysis aims to investigate steroid use trends in high school athletes and to determine whether there is an association between steroid use and concussions in these athletes. We conducted a cross-sectional analysis of the cumulative Youth Risk Behavior Surveillance System (YRBSS). Respondents were added if they participated in sports and answered the steroid and concussion prompts. Demographic variables were assessed including age, grade, BMI, gender, and race/ethnicity. We found that 3.7 % (n=2991) of high school athletes reported previous steroid use and that 20.7 % (n=2273) reported having sustained a concussion. There was a statistically significant difference in steroid use by race/ethnicity (p<0.001), with the highest rate of use (7.2 %) among American Indian/Alaska Natives (AI/AN). A significantly higher prevalence of steroid use occurred in athletes who were males (4.7 %) than females (2.5 %) and inathletes with a BMI>95 % (5.2 %) compared with those with a BMI between 85 and 95 % (3.9 %) and <85 % (3.5 %) (χ2=135.1, p<0.001 and χ2=16.3, p<0.001, respectively). Further, our results showed that the prevalence of steroid use among high school athletes decreased from 3.4 % in 1999 to 1.9 % in 2019, with the most drastic drop occurring between 2015 and 2019-declining 1.9 %. Whereas 19.6 % of athletes reported a concussion without steroid use, 54.6 % of steroid-utilizing athletes reported having experienced a concussion-a statistically significant finding (adjusted odds ratio [AOR]=4.3; 95 % CI: 3.2-5.9). Finally, compared with White athletes, we found that AI/AN athletes were significantly more likely to have sustained a concussion (AOR=2.3; 95 % CI=1.2-4.3). Although our study found decreasing rates of steroid use among high school athletes from 1999 through 2019, our results also show that steroid use is significantly associated with sustaining a concussion. Additionally, the data from YRBSS also demonstrates that AI/AN high school athletes are more likely to utilize steroids and sustain a concussion. Given the long-term consequences of traumatic brain injuries, we recommend that coaches should be aware of potential steroid use among players, and that coaches, athletic trainers, and physicians should all be aware of concussion protocols and remove players from games for evaluation when a concussion is suspected.

Utilization of Services and Clinical Outcomes among American Indian/Alaska Native (AIAN) Women with Breast Cancer at an Academic Medical Center (AMC)

AIAN patients have worse cancer outcomes than other races and may face barriers in accessing care. Data on healthcare utilization or outcomes for AIAN patients across healthcare systems are limited. We report patient characteristics, treatment patterns, and clinical outcomes for AIAN women with breast cancer seen at a tertiary AMC in the Pacific Northwest. We performed a retrospective chart review of self-identified AIAN women with an encounter for unilateral breast cancer between January /2000 and January 2021. Patient demographics; AJCC 8th prognostic stage; treatment (surgery, radiation, systemic therapy); were abstracted and summarized with median (interquartile range) or number (%) and compared with χ2 or t-tests. Progression-free (recurrent or new breast cancer) and overall survival (PFS; OS) were estimated per Kaplan-Meier and compared with log-rank tests. Of 21,013 patients with cancer encounters, 2,168 (10%) self-identified as AIAN and 246 (0.01%) were AIAN women with unilateral breast cancer. The median age at diagnosis was 52 (43 - 53) years; 37% lived in the same county as the AMC while 80% lived in the same state. At diagnosis, 181 (74%) had early-stage (0 - 2A), 24 (10%) locally-advanced (2B - 3), 30 (12%) non-metastatic, and 11 (4%) metastatic disease. Of the 181 (74%) women treated at the AMC, 39% lived in the same county; 86% had curative-intent therapy: 52 (71%) surgery, 114 (37%) radiation, and 65 (64%) systemic therapy; 26% had surveillance, oncoplastic surgery or non-cancer care only. Women who had surgery at the AMC were older (P < 0.01), less likely to live in the same county (40%, P = 0.4), had mostly early-stage disease (81%, P = 0.005), and were more likely to receive adjuvant therapy at the AMC (75%, P < 0.01). Patients treated for metastatic disease at the AMC (19%) rarely lived in the same county (21%, P = 0.03), or had prior treatment at the AMC (32%, P = 0.03); 92% had systemic therapy, 38% radiation, and 12% surgery. With median 6.4 (3.2 - 10.9) years follow-up, median OS for all AIAN patients was 51.4 (unreached [UR] - UR) years. Patients who presented to the AMC with metastatic disease had median OS 13.4 (8.4 - UR) years. With median 5.1 (2.6 - 9.3) years follow-up, median PFS was 20.6 (14.2 - UR) years, and longer for patients who received any curative-intent treatment at the AMC (P = 0.006). Most AIAN women with breast cancer seen at the AMC received curative treatment for early-stage disease with excellent outcomes. Most treated for metastatic disease had no prior treatment at the AMC and may be more likely to transfer care to the AMC to engage with specialized services or clinical trials, particularly for systemic therapy. Understanding the prognostic stage, treatment utilization, and outcomes of the AIAN patients served may allow us to improve cancer services and outcomes for this community.

The role of smoking in explaining racial/ethnic disparities in bladder cancer incidence in the United States.

Smoking is the most important modifiable risk factor for bladder cancer (BC), with the odds of developing BC among current and former smokers 3 times higher than never-smokers. We hypothesized that the observed disparities in BC incidence may be partially attributable to differences in smoking prevalence. We examined the attributable risk of BC related to smoking according to race/ethnicity and sex. We used data from SEER and the Behavioral Risk Factor Surveillance System to estimate BC cases that would have been prevented if current and former smokers had never smoked to calculate the Population Attributable Fractions, stratified by sex and race/ethnicity. SDs of BC incidences across racial/ethnic groups before and after smoking elimination were calculated to estimate disparities. A total of 25,747 cases of BC were analyzed from 21 registries in 2018. By removing smoking, 10,176 cases (40%) would have been eliminated. Smoking was associated with a higher proportion of BC cases among males (42%) than females (36%). Across racial/ethnic groups, smoking contributed to the highest proportion of BC cases among American Indian/Alaska Natives (AI/AN) (43%) and Whites (36%) for females, and highest among AI/ANs (47%) and Blacks (44%) for males. Removing smoking, the SD of BC incidence across racial/ethnic groups was reduced for females (39%) and males (44%). Approximately 40% of cases of BC in the United States are attributable to smoking, with the highest proportion in AI/ANs for both males and females, and the lowest in Hispanics for females and Asians and Pacific Islanders for males. Smoking contributes to almost half of racial/ethnic disparities in BC incidence in the United States. Accordingly, health policy to encourage smoking cessation among racial-ethnic minorities may substantially reduce inequalities in BC incidence.

The Association Between Resiliency Factors and Suicide Indicators Among American Indian/Alaska Native Middle School Students in New Mexico: A Strength-Based Analysis.

Suicide is a leading cause of death among American Indian/Alaska Native (AI/AN) young people aged 10-19 years in the United States, but data collection and reporting in this population are lacking. We examined results of an oversample project in New Mexico to determine the association between resiliency factors and suicide-related behaviors among AI/AN middle school students. We conducted analyses using data from the 2019 New Mexico Youth Risk and Resiliency Survey for students in grades 6 through 8. An oversampling method was used to increase the sample size of AI/AN students. We used logistic regression to determine the association between resiliency factors and suicide indicators among AI/AN students, stratified by sex. Among female AI/AN students, community support had the strongest protective effect against having seriously thought about suicide (adjusted odds ratio [aOR] = 0.23; 95% CI, 0.14-0.38), while family support was significantly associated with the lowest odds of having made a suicide plan (aOR = 0.15; 95% CI, 0.08-0.28) and having attempted suicide (aOR = 0.21; 95% CI, 0.13-0.34) (P < .001 for all). Among male AI/AN students, school support had the strongest protective effect against all 3 outcomes: seriously thought about suicide (aOR = 0.34; 95% CI, 0.19-0.62; P < .001), having made a suicide plan (aOR = 0.19; 95% CI, 0.09-0.39; P < .001), and having attempted suicide (aOR = 0.27; 95% CI, 0.12-0.65; P = .003). Oversampling AI/AN young people can help accurately quantify and understand health risk behaviors and strengths of this population, leading to improved health and wellness. Family, community, and school-based support should be considered in interventions geared toward suicide prevention among AI/AN young people.

Comparing Behavioral Health Outcomes and Treatment Utilization of Those With and Without Justice Involvement Within the Past Year Among American Indian and Alaska Native Adults.

Similar to other populations, worse health, increased emergency healthcare utilization, and heightened substance misuse are correlated with higher justice involvement among American Indian/Alaska Native (AI/AN) populations. The historical context and resulting contemporary injustices for AI/AN populations have directly contributed to higher rates of these health and behavioral health conditions among this population. As a result, AI/AN individuals have disproportionate rates of incarceration in the USA, with young AI/AN males having the highest odds of incarceration when compared to any other group. American Indian and Alaska Native populations are overrepresented in the criminal justice system across different touchpoints. However, there remains a scarcity of data and research on AI/AN peoples' involvement with the justice system, and what their lives look like prior to, during, and after justice involvement. The current study addresses this gap in the literature by exploring rates of substance use and mental health diagnoses and treatment utilization among justice-involved and non-justice-involved AI/AN samples. Further, we examined correlates associated with past-year service utilization. Data from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 adults aged 18+) was used. For this study, we examined a subsample of 3068 AI/AN adults. Quantitative data analyses using STATA 16 were run to test for differences on service utilization, mental health status, and substance misuse between AI/AN non-justice-involved and justice-involved samples. Among adults in the sample, 446 (15%) reported justice involvement in the past year. Justice-involved AI/AN individuals were significantly more likely to use the emergency department, utilize mental health treatment, and access substance use treatment in the past year. Additionally, justice-involved AI/AN individuals reported significantly higher rates of mental illness and past-year substance use disorder. In regression models, justice involvement was significantly associated with past-year substance use treatment and past-year mental health treatment. The findings from this work highlight the differences among substance use, mental illness, and treatment utilization between justice-involved and non-justice-involved AI/AN individuals. Findings suggest that justice-involved individuals fair worse in all areas and argue for the consideration of interventions that incorporate both culturally sensitive and justice-responsive models to improve the behavioral health outcomes of these populations. Lastly, while justice-involved AI/AN populations utilize treatment services at higher and disproportionate levels, there is reason to believe that there continues to be a mismatch of need and utilization and further exploration is warranted.

Past Cannabis Use, Health-Related Worry, and Beliefs About Perceived Benefits of Cannabis Among American Indians/Alaska Natives.

Most adults report beliefs that cannabis has at least one benefit (e.g., stress relief, chronic pain management); however, the benefits are not well established. Beliefs about cannabis benefits are associated with the initiation of use, whereas beliefs about the risks of cannabis are protective factors against its use. Little is known about how health-related beliefs impact cannabis use among American Indians/Alaska Natives (AIAN). This exploratory study examined beliefs about perceived benefits (i.e., stress relief, pain management) of cannabis, how beliefs vary as a function of use, and associations between health worry and benefits of cannabis among AIAN adults. Participants (n = 182) were on average 41.4 (SD = 16.3) years old, 63.9% female, and identified as AIAN. Participants were asked questions about general demographics, health-related worry and perceptions, and cannabis use. Linear regressions were conducted to examine associations. Those who used cannabis in the past year were more likely to agree that cannabis relieves stress and less likely to believe that those who use cannabis should be very worried about their health. Participants who agreed that those who use cannabis should be worried about their health were less likely to report beliefs that cannabis relieves stress or helps with chronic pain. Our study confirms the role of health-related perceptions and worry about cannabis products with cannabis use among this population that may be at risk for higher cannabis use. Findings may have implications for cannabis policy at the tribal, state, and federal levels and the need for the development of targeted communications about the true health risks of cannabis.

Factors Associated with Child Removal Among American Indian and Alaska Native People in an Alcohol Intervention Study.

This study was a secondary data analysis of factors associated with alcohol-related child removal among American Indian/Alaska Native (AI/AN) adults enrolled in a clinical trial of an alcohol intervention. Among 326 parent participants, 40% reported ever having a child removed from their care in part because of the parent's alcohol use, defined here as alcohol-related child removal. Seventy-five percent of parents reported at least one separation during their own childhood (M = 1.3, SD = 1.0). In a multivariable analysis, alcohol-related child removal was associated with parental boarding school attendance. No relationship was found between alcohol-related child removal and alcohol intervention outcomes. Results may provide evidence of multigenerational child removal impacts of boarding schools on AI/AN adults receiving an alcohol use disorder intervention. Assessment of parental history of child removal by practitioners, strategies to prevent alcohol-related separation and to support reunification should be integrated into addiction treatment in AI/AN communities.

Racial Disparities in Spatial and Temporal Youth Suicide Clusters.

Deaths by suicide correlate both spatially and temporally, leading to suicide clusters. This study aimed to estimate racial patterns in suicide clusters since2000. Data from the US National Vital Statistics System included all International Classification of Diseases, Tenth Revision (ICD-10)-coded suicide cases from 2000-2019 among American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (A/PI), Black, or White youth and young adults, aged 5-34 years. We estimated age, period, and cohort (APC) trends and identified spatiotemporal clusters using the SaTScan space-time statistic, which identified lower- and higher-than-expected suicide rates (cold and hot clusters) in a prespecified area (150 km) and time interval (15 months). We also calculated the average proportion of deaths by suicide contained in clusters, to quantify the relative importance of spatiotemporal patterning as a driver of overall suicide rates. From 2010-2019, suicide rates increased from between 37% among AI/AN (95% CI= 1.22, 1.55) to 81% among A/PI (95% CI= 1.65, 2.01) groups. Suicide clusters accounted for 0.8%-10.3% of all suicide deaths, across racial groups. Since 2000, the likelihood of detecting cluster increased over time, with considerable differences in the number of clusters in each racial group (4 among AI/AN to 72 among White youth). Among Black youth and young adults, 27 total clusters were identified. Hot clusters were concentrated in southeastern and mid-Atlantic counties. Suicide rates and clusters in youth and young adults have increased in the past 2 decades, requiring attention from policy makers, clinicians, and caretakers. Racially distinct patterns highlight opportunities to tailor individual- and population-level prevention efforts to prevent suicide deaths in emerging high-risk groups.

Implications for Coding Race and Ethnicity for American Indian and Alaska Native High School Students in a National Survey.

To examine the impact of racial/ethnic coding strategies on the estimated prevalence of risk behaviors among American Indian/Alaska Native (AI/AN) high school students. Data from the national Youth Risk Behavior Survey (2017 and 2019) were analyzed (N=28,422). Racial/ethnic data were coded to identify "Multiracial/ethnic AI/AN students" and "AI/AN alone students." The prevalence of persistent feelings of sadness or hopelessness, suicidality, and violence victimization were compared across the coding schemes and with non-Hispanic White students. Of students who selfidentified as AI/AN, one in six (18%) were AI/AN alone. The prevalence of many health risk behaviors was significantly higher among AI/AN students than non-Hispanic/Latino White students. The precision of the risk behavior prevalence estimates, however, varied considerably. How racial/ethnic data were coded affected the precision of calculations of risk behavior prevalence among AI/AN students, who are often multiracial and of Hispanic/Latino ethnicity.

"Cancer Center Catchment Area Assessment"-Letter.

We thank Leader and colleagues (1) for the first published article that explores the geographic coverage of U.S.-based cancer centers’ catchment areas. The use of county-level data and aggregated cancer statistics provides some insights regarding coverage of the U.S. population by cancer centers; however, more granular data are required for a fuller understanding of coverage gaps, as mentioned in the article. We share two relevant observations here.First, the study found gaps in coverage in some states with rural populations but results also showed that most of the counties with balanced or overcoverage (population density overlay score > = 0) belong to the lower quintiles of population density, suggesting that the use of population density may downplay the challenges that come with reaching rural populations (2). Conversely, 48 of the 50 most densely populated counties exhibited undercoverage (population density overlay score < 0). As with the oversimplification of coverage in rural counties, using population density to assess coverage in densely populated and diverse catchment areas is not sufficient to fully characterize the reach of cancer centers, where neighborhood data are required.Similarly, the need for cancer incidence and mortality data disaggregated by race/ethnicity, sexual orientation, and gender identity (3) is generally recognized but still lacking. In our own analysis of the Centers for Disease Control 2014–2018 county-level combined data that were used in the study (excluded counties in Kansas and Minnesota for which data were not available), we found, for example, that 2,335 U.S. counties were missing all-site incidence data for Asian/Pacific Islanders, and, when available, data for Asians and Pacific Islanders were aggregated despite disaggregation being the minimum standard for all Federal reporting purposes (4). We noted that 145 of these 2,335 counties are in the highest quartile of Asian American population size (mean Asian American population size: 3,702) and 141 of these counties are in the highest quartile of Native Hawaiian and Pacific Islander (NHPI) population size (mean NHPI population size: 345; ref. 5). The discrepancy was largest among American Indian/Alaska Native (AIAN): there were 2,462 counties without all-site incidence data specific for this group, even for 285 counties belonging to the highest quartile of AIAN population size (mean AIAN population size: 2,020). If our aim is to be able to measure potential future impact on our catchment area, we first have to advocate for the disaggregation of cancer data for minority populations who have been invisible in these data.No disclosures were reported.This work is supported by Cedars-Sinai Medical Center.

Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017

Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study’s objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0–24 months in Montana, a large and primarily rural U.S. state. Data from Montana’s immunization information system (IIS) for children born 2015–2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations &#x2013; a review.

This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.

Abstract PO-026: University of Arizona partnership for Native American Cancer Prevention (NACP), outreach core

Abstract Cancer among American Indian/Alaska Native (AI/AN) communities is the second leading cause of death. The Partnership for Native American Cancer Prevention (NACP) was established to addresses cancer health disparities in Native Americans. The Outreach Core of NACP ensures research and tribal community engagement are undertaken in a respectful and inclusive manner with tribal communities. The University of Arizona (UA) Outreach Core: (1) developed (&amp; distributed to 22 Arizona tribal communities) information materials focused on proper tribal consultation and engagement, foundational cancer information including statistics on leading causes of cancers, considerations for cancer survivors and caregivers over the continuum of cancer care including palliative/hospice care and clinical trials. (2) Hosts an Indigenous Cancer Prevention webinar series to showcase successful community-led cancer control initiatives in Indian Country. (3) In collaboration with the UA Responsible Conduct of Research (RCR) Program, offer training in Tribal Consultation &amp; Engagement with Native Communities. (4) Partnered to develop a well-women video to promote preventative cancer screening of Native American women. As part of the Indigenous Cancer Prevention webinar series, a total of seven speakers have presented on various Native American-focused cancer initiatives including: understanding pediatric acute lymphoblastic leukemia, initiatives to address cancer burden; human papillomavirus and cervical cancer; quality of life among cancer survivors and survivorship issues; cancer among Alaska Natives; and cancer trends in Indian Country. Both the webinar series and the UA RCR training have been well received and pre- and post-tests and evaluations demonstrate an increase in knowledge and positive review of content and delivery. The webinar series has reached over 200 attendees of students, service providers, community members, and faculty across half of the United States. Citation Format: Keyauni Leist, Jacquanette Slowtalker. University of Arizona partnership for Native American Cancer Prevention (NACP), outreach core [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-026.

Chronic Diseases and Self-Reported Health Status Among American Indian/Alaska Native Older Adults

Background: In the 1800s and 1900s, U.S. federal “Indian” policy (e.g., boarding schools, relocation) created historical trauma with impacts that reverberate today, such as the significant health challenges experienced among American Indian/Alaska Native (AI/AN) populations. Our study seeks to better understand the burden of chronic disease, and also resilience, among AI/AN older adults. Methods: Data came from Cycle VII (2018-2020) of the National Resource Center on Native American Aging’s “Identifying Our Needs: A Survey of Elders” survey of AI/AN adults ages 55+ from primarily rural tribal survey sites (N=20,642). Analysis explored self-assessed health status (very good/excellent, good, fair/poor) and looked for significant differences in prevalence of chronic conditions a doctor ever told them they had (e.g., high blood pressure, diabetes, depression, arthritis, asthma). Results: Self-reported health among AI/AN adults age 55+ was: 26% very good/excellent, 39% good, and 35% fair/poor. 87% of respondents had 1+ chronic illness; 37% had 3+. Among those reporting very good/excellent health, 75% had 1+ chronic illness and 19% had 3+. High blood pressure was the most common chronic disease, at 56% (44% for very good/excellent compared to 67% for fair/poor), followed by diabetes, at 36% (24% for very good/excellent compared to 46% for fair/poor). Conclusions: All of the chronic conditions examined showed significantly higher prevalence among AI/AN adults 55+ with fair/poor health. Notably, 1 in 5 respondents with 3 or more chronic conditions indicated very good/excellent health, reinforcing that successful aging can still be experienced by those with chronic health conditions.