Annals of Anthropological PracticeVolume 41, Issue 1 p. 35-40 ErratumFree Access Erratum This article corrects the following: Tuberculosis morbidity at Haskell Institute, a Native American Youth Boarding School 1910–1940:∧ RACHEL E. WILBUR, STEVEN M. CORBETT, JEANNE A. DRISKO, Volume 40Issue 1Annals of Anthropological Practice pages: 106-114 First Published online: October 26, 2016 First published: 20 August 2017 https://doi.org/10.1111/napa.12109AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In [1], the following updates were made to this article. An editorial error resulted in the publication of the wrong version. The online article has been amended on 4 August 2017. The title has been updated to: Tuberculosis morbidity at Haskell Institute, a Native American Youth Boarding School, 1910–1940: Impacts of historical and existing social detriments of health. The abstract has been updated to: Objective: To determine historical disparities in tuberculosis morbidity between Native American youth attending off reservation government boarding schools and the non-Native American population. Findings are placed within the context of documented health disparities in Native American populations, with implications for modern health. Methods: Analysis performed on available epidemiologic data from Haskell Institute in Kansas and corresponding statewide data for points in time between the years 1910–1940. Data on tuberculosis prevalence and enrollment for Haskell were collected via historical records. Tuberculosis morbidity rates were calculated, along with comparative tuberculosis morbidity for the state of Kansas. Results: Tuberculosis rates at Haskell Institute were significantly (p<0.0001) higher than for the state of Kansas from 1910–1940. Conclusions: Tuberculosis morbidity among Native American boarding school youth in the early 20th century was higher than among the general public. Entrenched social and historical determinants resulted in increased susceptibility to tuberculosis; these factors continue to be associated with increased rates of tuberculosis among Native Americans today. In the first paragraph of the Introduction on page 106, a second sentence has been added. The text now reads: Boarding schools isolated children from their families and tribes and strictly enforced Eurocentric regulations regarding food, clothing, hairstyle, and language. Traditional cultural and spiritual practices were strictly prohibited. A last paragraph has been added in the Introduction on page 107. The text now reads: We examined historical records from Haskell Institute at the beginning of the 20th century in order to determine whether Native American children at boarding schools, like Haskell Institute, experienced higher rates of tuberculosis than would be expected given national prevalence at the time. Haskell Institute was chosen because of its size, age, and availability of records. Like most boarding schools, Haskell Institute drew children from many tribes (Child 1998), a practice which was intended to further isolate children from their cultural heritage and which, in this case, indicates that high rates of TB within the school cannot be attributed to high prevalence within a single tribe. Haskell Institute was particularly well-suited to analysis due to the existence of both quantitative as well as qualitative records. Clinical data was available in the form of infirmary records while journals and narratives from students and staff provided context for the social and cultural environment within which infection and treatment occurred. In the Methods section under the Data Collection subheading on Page 107, a sentence has been added to the end of the last paragraph. The text now reads: National TB mortality statistics are available in Vital Statistics Rates in the United States 1900–1940, published by the National Bureau of Economic Research (United States Public Health Service 1947), while state-specific TB prevalence for the state of Kansas was received through the TB Information Specialist at the Kansas Department of Health and Environment from a report published in 1965 by the Division of Disease Prevention and Control in the Kansas State Department of Health titled “Tuberculosis in Kansas” (Wilcox 1965). The population of the state of Kansas during the years of interest was attained through the United States Census website, specifically the webpage: State Population Estimates and Demographic Components of Change: 1900–1990 Total Population Estimates (U.S. Census Bureau 2011). An attempt was made to find data from non-Indian boarding schools in Kansas for the time period. The attempt was unsuccessful as the three schools operating in the state at that time did not maintain their health records. In the Methods section under the Data Analysis subheading on Page 107, text was added after the sentence beginning “Annual TB morbidity for the state….” and in the last sentence beginning with “The statistical analysis software….”. It now reads: Annual student enrollment statistics were used in combination with prevalence rates to calculate annual TB morbidity at Haskell for the years 1910–1920, 1931–1933, and 1936–1938. Annual TB morbidity for the state of Kansas was also calculated using Kansas state prevalence rates and yearly population data. Kansas-specific data was available in five year age increments up to age 20, which we compiled into two categories: under twenty and total TB morbidity. As age data was not available for Haskell Institute, the under 20 year category was felt to most accurately correspond to the school-age demographic present at Haskell Institute. Demographic information was available for Haskell Institute students, however it was not tied to infirmary records and was therefore determined to be of limited use in our analysis. Graphical representations of the data were created using excel, showing the annual TB morbidity of Haskell Institute and the state of Kansas. The statistical analysis software SPSS and the Mann-Whitney U-test was used to assess differences between annual Haskell Institute and Kansas TB morbidity rates as the groups were independent and the dependent variable was continuous but not normally distributed. In the Results section, a sentence was added after the sentence beginning with “Figure 1 shows similar patterns….”. The text now reads: The TB morbidity of Haskell Institute during the years examined was determined to be significantly different (p<0.0001) from the TB morbidity of the state of Kansas during the same period. Figure 1 shows similar patterns for TB morbidity variation over the years examined, but with significantly higher rates for Haskell Institute compared to the state of Kansas. The year-to-year variation in TB morbidity at Haskell Institute during the years reviewed is within the SD (0.0131) and therefore likely not indicative of real shifts in morbidity. Statistical anomalies are likely based on small sample size. Figure 1Open in figure viewerPowerPoint Haskell Institute and Kansas state TB morbidity during the time period under analysis. A new Figure 1 has been added and the previous Figure 1 has been renamed to Figure 2. In the Discussion section on page 109, text has been added to the first sentence of the first paragraph. The text now reads: The high TB morbidity rate discovered at Haskell Institute compared to the state of Kansas over the period 1910–1940 is not unusual or unexpected, and —– early variation in morbidity rate at Haskell likely resulted small sample size. In the Discussion section, text has been added to the last sentence of the second paragraph. The text now reads: Changing morbidity rates over time (Omran 1975), however, and morbidity differences by socioeconomic status (SES) (McKeown 1976), appear to indicate the importance of environment in TB susceptibility and implicate gene-environment interaction as the primary indicator for TB risk. Figure 2Open in figure viewerPowerPoint Kansas State and Haskell Institute TB morbidity rate over time, 1910–1940 In the Components of environmental susceptibility crowding on page 110, a subheading has been added and text has been removed from the first paragraph. The text now reads: Historic A 2009 multilevel analysis of TB risk factors found a significant association between crowding and recent TB infection (Harling 2008). In 1909, Hrdlička noted that housing structures among many Native American tribes were small and crowded, with limited ventilation in the winter months when homes were insulated against the cold. With TB rampant on reservations, non-reservation boarding schools were originally seen as a means to reducing the disease burden via assimilation (Keller 2002). In the Components of environmental susceptibility crowding a second subheading has been added and text has been added to the first sentence of the paragraph. The text now reads: Modern Day Today, low landlord return-on-investment has resulted in a shortage of available rental housing on reservations. The lack of available housing, compounded by traditional practices of multigenerational cohabitation, result in housing density rates conducive to respiratory infectious disease transmission. In 2013, 8.8% of homes on reservations were overcrowded compared to only 3% in the rest of the country (Housing Assistance Council 2013). And while many reservations are largely rural, typically considered beneficial in the prevention of air-borne communicable diseases (McCarthy 2001), a 1960s United States Department of Housing and Urban Development (HUD) report promoted close clustering of single family and mobile homes on reservations as an efficient method for delivering services to rural areas (Housing Assistance Council 2013). Because of this, even on rural reservations, the majority of the population resides in close proximity to one-another. In the Diet section, two subheadings have been added before the first and second paragraphs. They are: Historic Modern Day In the Access to care section, two subheadings have been added before the first and third paragraphs. They are: Historic Modern Day In the Access to care section under the Modern Day subheading, text has been added to the second sentence in the first paragraph. The text now reads: Common misconceptions exist regarding access to care through Indian Health Services (IHS), and differences exist between populations residing on reservations compared to those in urban centers. A new section consisting of six paragraphs and a new Figure 3 have been added after before the section Decreasing incidence of TB. Figure 3Open in figure viewerPowerPoint Average tuberculosis mortality rates: 1910–1920, 1931–1933, 1936–1939 for the United States, Kansas, and Native Americans by age. The Broader TB Environment Previously published data indicates that Haskell had a relatively low TB morbidity rate compared to other non-reservation boarding schools throughout the U.S. (Keller 2002), suggesting that geographic region may have played a role in TB prevalence. It is well-known that certain climates were considered beneficial in the treatment of TB, an explanation used by government statisticians and health workers in the early 20th century to explain higher rates of TB morbidity in some regions than others (CDC Vital Statistics 2013). Comparative historical data from the region are limited due to a lack of reporting and minimal emphasis on the collection of health statistics at the time. Kansas had only recently become a Registration State for the Mortality Statistics of the U.S. Bureau of the Census in 1914 (Bureau of the Census 1930). The Kansas State Tuberculosis Association began in 1908 as the Kansas Association for the Study and Prevention of Tuberculosis. In the early part of the century the TB mortality rate in Kansas was low and on the decline due to the rural setting and lack of large population centers and newly organized prevention efforts (Knopf, S.A. 1922). The state of Kansas had few non-Indian boarding schools, and as private institutions, such schools were under no federal or state mandate to collect and maintain health data on their pupils. There were, however, a few Native American tribes in the region who compiled and retained records on TB. While these sources do not allow a direct comparison with the population at Haskell Institute, they do provide information about the larger social, pathogenic, and physical environment through which to further understand our findings at Haskell Institute. The Prairie Band Potawatomi reservation, located approximately 50 miles from Haskell Institute, participated in a comprehensive health survey in 1928. TB was often cited as the most common serious illness and data from the survey also reveals TB to have been the most common cause of mortality, accounting for 13% of all deaths. The incidence of TB for 1928 on the Potawatomi reservation was 2.4%, with a prevalence of 8%, indicating a much higher rate on the reservation compared to the rest of the state of Kansas (Corbett & Drisko 2011). Earlier, in 1917, a physician named Margaret Koenig performed what she referred to as a “social study” on a Winnebago reservation in Nebraska. Her review found rampant rates of active TB, ultimately estimating that one in eight Winnebago suffered from some form of active or latent TB. The mortality rate from TB among the Winnebago was also almost twice the proportion of the United States. While TB was noted to be prevalent among the Winnebago generally, Dr. Koenig noted that in 1917 a greater percentage of those ill among the Winnebago were youths. On the reservation, 50% of those diagnosed with TB were below the age of 20, while in the larger United States the rate was 17.5% (Koenig 1921).The percentage of youth in the population suffering from TB is further supported by statistics from the Kansas State Tubercular Sanatorium in Topeka, Kansas. From 1922–1940, 21.8% of those treated were listed as “students” (Biennial Report 1912–1958). While these data are not directly comparative to our population as those sent to the Sanatorium are likely to have been of a higher socioeconomic class, the ratio of youth to adult sufferers appears to have remained relatively stable. The Centers for Disease Control and Prevention (CDC) was one of the few health organizations in the early 20th century maintaining mortality statistics for the United States. These statistics were published annually in reports simply titled “Mortality Statistics”, followed by the year. Mortality Statistics reports show a consistently higher mortality rate in both the nation as a whole, as well as the state of Kansas, within the segment of the population under the age of 20 during the years 1910–1920, 1931–1933, and 1936–1938 (Figure 3). For the years in which data is available, the TB mortality rate within those identified as “Indian” is higher than both state and national averages, although with limited sample size it is not possible to determine significance (CDC Vital Statistics 2013). (Include Figure 3 here). It is plausible that students in an institutional setting such as a boarding school would be more likely to receive a diagnosis of TB than the general population. However, as early as 1914 pressure was being placed on physicians to report and follow-up with patients diagnosed with TB. In fact, a “check system” was established by the Kansas State Board of Health which allowed for prosecution of providers found to be negligent in diagnosing and reporting cases of TB within the state (Biennial Report 1912–1958). Neither reports of the Kansas State Tuberculosis Association or the State Sanatorium address the possibility that they were not reaching and counting all infected patients. In the Study limitations section, text has been added from the first sentence of the first paragraph. The text now reads: This study has several limitations, the most salient of which is the difficulty of working with historical data, which presents challenges not found when working with modern data. Historical data is inherently observational, in that the researcher is reliant upon statistics and data that were noted, recorded, and preserved by someone in the past. At the beginning of the 20th century, from when our data is derived, there was very little consistency of data collection between or across organizations. Data collection activities would have been interrupted by two World Wars and a depression during the time period examined, and as such data was not required to be collected at all, such interruptions combined with often insufficient staffing resulted in data being unrecorded or unavailable for a number of the years included in this review. While such inconsistencies make working with historical data a challenge, they do not diminish the richness of information available through the careful analysis of such data, and they should not alter the impact of the findings. Missing information, due to inconsistent or inadequate record keeping, the impact of natural disasters on paper records, or other elements of time, resulted in an incomplete timeline of TB morbidity at Haskell Institute. This, combined with antiquated terminology, limited diagnostic capabilities, and the potential desire on the part of Haskell administration to downplay the severity of disease, necessitated a number of assumptions on the part of researchers when compiling data. Therefore, although we believe the data to be an accurate representation of TB morbidity at Haskell Institute during the period from 1910-1040, the potential remains for slight variation from true values. We apologize for any inconvenience caused. Reference 1Wilbur, R. Corbett, S. and Drisco, J. (2016) Tuberculosis Morbidity at Haskell Institute, a Native American Youth Boarding School, 1910–1940: Impacts of Historical and Existing Social Determinants of Health. J. Annals of Anthropological Practice 40, 106– 114. Volume41, Issue1May 2017Pages 35-40 FiguresReferencesRelatedInformation