Native American Health Research Articles

Native American Adolescent and Young Adult Sexual Health Inequities: A Short Review

Native American Adolescent and Young Adult Sexual Health Inequities: A Short Review

Engagement with reservation-based Head Start teachers to explore their stress and coping: A qualitative study

BackgroundNative Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked. MethodsQualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes. ResultsIndividually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being. ConclusionsThis paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.

Participatory training evaluation: Steps from the Center for Native American Health Native-CHART symposium

This paper presents a case example of the Native-CHART Training Evaluation and describes the process of planning and administering a paper evaluation during the Native-CHART symposium in November 2019 led by the Center for Native American Health (CNAH) and an external evaluator. Training evaluation methodologies and the data collection instrument were grounded in the Health Belief Model (HBM) where health-related chronic disease and risk factor knowledge translates to perceived susceptibility, benefits, barriers, and self-efficacy. Kirkpatrick's Four-level Training Evaluation Model explored learning, reaction, behaviors, and results. The evaluation aims centered around the following questions: 1)Who attended the symposium, and why did they attend? 2)What knowledge did participants gain at the symposium? 3)Will attendees change their behaviors as a result of attending the symposium? 4) What parts of the symposium were most valuable? And 5) How can the symposium be improved? Data collected at the symposium answered these questions. After the Native-CHART symposium, CNAH staff and the external evaluator met to reflect on the steps necessary to plan and implement a participatory training evaluation. From these discussions, eight steps emerged. This paper presents these steps along with recommendations for future work. Participatory and collaborative approaches in training evaluation and the steps included in this case example may be useful to evaluators, communities, and programs working on designing and evaluating various trainings with Tribal populations.

Abstract A093: Implementation of a financial hardship screening among Native American patients with cancer

Abstract Introduction: Financial hardship and financial hardship screening are emerging concerns in oncology. Native American patients may be at increased risk of financial hardship due to factors including poverty, medical comorbidities, and lack of private health insurance coverage. Financial hardship for Native American patients with cancer has only rarely been studied, and implementation of screening for financial hardship for these patients has never been reported. Methods: Guided by input from a stakeholder advisory board consisting of patient, provider, and staff members at a single cancer center in Oklahoma, we implemented a financial hardship screening tool, the COmprehensive Score for financial Toxicity (COST) – Functional Assessment of Chronic Illness Therapy (FACIT) among 42 Native American patients with cancer. We conducted key informant interviews with ten of these patients and four clinical staff involved in the implementation process. Patient interviews included questions about current financial hardship, experiences in discussing financial hardship with the cancer care and primary care team, and acceptability of the COST-FACIT tool. Clinician interviews focused on their experience with the project, including implementation of the COST-FACIT tool, barriers to implementation, and sustainability. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. COST-FACIT tool data were analyzed using SAS v. 9.4 Results: Three-quarters (76%, n=32) of participants who completed the COST-FACIT tool reported moderate or severe financial hardship (Score <25 out of max 44, with lower scores indicating more hardship). A higher percentage of patients experiencing financial hardship were younger, covered by Medicaid, unemployed, not married/cohabiting, had lower income, and lower education compared to those with no/mild hardship (Scores ≥25). Among patients and clinicians, we identified themes of 1) financial hardship screening perception and intervention experiences, 2) screening efficacy and opportunities for improvement, and 3) systematic and patient related themes of Native American health systems and culture. Conclusions: Financial hardship was reported by the majority of Native American patients with cancer included in our study. Patients expressed a positive experience with the screening tool, including identification of financial challenges though timing of the tool in regards to their cancer diagnosis varied across patients. Clinicians experienced challenges in implementation of the COST-FACIT tool related to logistics, the COVID-19 pandemic, and concerns for sustainability. However, clinicians reported a positive experience with the tool and interactions with patients and referrals that resulted from the screening. Citation Format: Amanda E. Janitz, Amber S. Anderson-Buettner, Stefani D. Madison, Mark P. Doescher, Dorothy A. Rhoades. Implementation of a financial hardship screening among Native American patients with cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A093.

Unsettling Settler Colonialism in Research: Strategies Centering Native American Experience and Expertise in Responding to Substance Misuse and Co-occurring Sexual Risk-Taking, Alcohol-Exposed Pregnancy, and Suicide Prevention Among Young People.

Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people.

The statue of Susan La Flesche Picotte (1865-1915): A pioneer of Native American public health.

The statue of Susan La Flesche Picotte (1865-1915): A pioneer of Native American public health.

Improving the representativeness of the tribal behavioral risk factor surveillance system through data integration

BackgroundPrevious literature showed significant health disparities between Native American population and other populations such as Non-Hispanic White. Most existing studies for Native American Health were based on non-probability samples which suffer with selection bias. In this paper, we are the first to evaluate the effectiveness of data integration methods, including calibration and sequential mass imputation, to improve the representativeness of the Tribal Behavioral Risk Factor Surveillance System (TBRFSS) in terms of reducing the biases of the raw estimates.MethodsWe evaluated the benefits of our proposed data integration methods, including calibration and sequential mass imputation, by using the 2019 TBRFSS and the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). We combined the data from the 2018 and 2019 BRFSS by composite weighting. Demographic variables and general health variables were used as predictors for data integration. The following health-related variables were used for evaluation in terms of biases: Smoking status, Arthritis status, Cardiovascular Disease status, Chronic Obstructive Pulmonary Disease status, Asthma status, Cancer status, Stroke status, Diabetes status, and Health Coverage status.ResultsFor most health-related variables, data integration methods showed smaller biases compared with unadjusted TBRFSS estimates. After calibration, the demographic and general health variables benchmarked with those for the BRFSS.ConclusionData integration procedures, including calibration and sequential mass imputation methods, hold promise for improving the representativeness of the TBRFSS.

Graduate Medical Education Training and the Health of Indigenous Peoples.

Graduate Medical Education Training and the Health of Indigenous Peoples.

Tlacoqualli in Monequi "The Center Good"

Tlacoqualli in Monequi "The Center Good"

The Association of Race, Ethnicity, and Poverty With Child Maltreatment Reporting.

To determine the role of race/ethnicity and poverty in the likelihood of children younger than age 3 years hospitalized because of child abuse and neglect-related injuries being reported to child protective services (CPS) and being assigned a specific maltreatment diagnostic code. We used population-based linked administrative data comprising of birth, hospitalization, and CPS records. Children were identified for maltreatment-related hospitalizations using standardized diagnostic codes. Regression models were used to compute crude and adjusted race/ethnicity estimates regarding the likelihood of being reported to CPS and assigned a specific maltreatment diagnostic code during the maltreatment-related hospitalization. Of the 3907 children hospitalized because of child maltreatment, those with public health insurance were more likely than those with private insurance (relative risk [RR]: 1.29; 95% confidence interval [CI], 1.16-1.42) and those with Asian/Pacific Islander mothers were less likely than those with White mothers to be reported to CPS (RR: 0.78; 95% CI, 0.65-0.93). No differences were found for children with Black, Hispanic, and Native American mothers compared with those with White mothers for CPS reporting. However, children with Native American mothers (RR: 1.45; 95% CI, 1.11-1.90) and public health insurance (RR: 2.00; 95% CI, 1.63-2.45) were more likely to have a specific maltreatment diagnostic code, the second strongest predictor of a CPS report. Race/ethnicity and poverty were factors for CPS reports during a child maltreatment-related hospitalization. It is necessary to implement programs and policies that mitigate implicit bias to prevent inequities in which children receive protective intervention.

P120 Methods for Adapting Medical Clinic Referral to EFNEP to Serve Rural Native American Communities Via Telehealth

<h3>Objective</h3> The objective is to develop methods to adapt an in-person urban medical clinic-based intervention to a telehealth modality serving Native Americans in a rural setting where health disparities are more pronounced. <h3>Use of Theory or Research</h3> The Expanded Food and Nutrition Education (EFNEP) program intervention is based on Social Cognitive Theory and adult learning strategies. The adaptation methods are driven by the community-based participatory implementation science framework. <h3>Target Audience</h3> Native American families residing in rural California communities. <h3>Program Description</h3> Parents with young children are referred by physicians to attend an intervention (8-weekly sessions) delivered via telehealth by EFNEP educators. The intervention is focused on obesity prevention utilizing Guided Goal Setting, obesity risk assessments, storytelling, and food-related parenting topics. <h3>Evaluation Methods</h3> Meetings (n = 4) were convened over a four month period to develop a multi-phased community-based participatory approach to adapt the intervention. Members included the State EFNEP Director and County Program Advisors (n = 2), EFNEP educator, Indian Health Center Outreach Director, Pediatric Endocrinologist, Public Health Nurse, Nutrition Education Professor, Nutrition Specialist, and Human Development Specialist with over half having experience working with rural and Native American communities (n = 6). <h3>Results</h3> A three-phased approach was identified: formative, capacity bridging, and referral model implementation with each rooted in community-based participation. Community asset mapping will be conducted in the formative phase to outline healthcare partners serving Native American communities. A community advisory board consisting of Native American elders, Tribal chairs, parents, educators, and health care providers will be created for consultation on all phases including intervention content modification, identification of community/tribal health clinic partners, and inform referral and telehealth delivery strategies. <h3>Conclusions</h3> Adapting an intervention to a different target audience, location, and modality necessitates a thorough process to ensure relevance and sustainability. A three-phased approach with community-based participation was developed that can be used by other programs. <h3>Funding</h3> NIFA

Siobhan Wescott: steadfast advocate for Native American health

At preschool in Cambridge, MA, USA, during the early 1970s, Siobhan Wescott recalls being attacked by her fellow classmates for being a Native American. “At 4, I physically experienced racism for the first time. That really shaped my wanting to not have people feel uncomfortable in new places just because of the colour of their skin or their identity”, she says. Wescott, who is Alaskan Athabascan, became the inaugural Dr Susan and Suzette LaFlesche Professor of American Indian Health and Director of the American Indian Health Program in the College of Public Health at the University of Nebraska Medical Center (UNMC), Omaha, NE, USA, in July, 2021. “Dr Susan was the first Native American physician”, she tells me, but the LaFlesche sisters were “both very strong public health advocates”. This position is a fitting one for Wescott, who says, “public health is my passion”.

Native Voices Exhibition: Stories of health, wellness, and illness from American Indians, Alaska Natives, and Native Hawaiians.

The U.S. National Library of Medicine (NLM) exhibition known as Native Voices reflected Donald A.B. Lindberg M.D.’s keen and long-held desire to help improve public understanding of Native American health challenges and honor the culture, tradition, and healing ways of Native Peoples. A centerpiece of the exhibition was a large set of video interviews that Dr. Lindberg conducted with Native health and community leaders. Dr. Lindberg and his team engaged Native advisors in the exhibition development; sought Native input through Listening Circles, Tribal Consultations; and site visits, and made the video interviews accessible via interactive kiosks and iPads. For its time, this was state-of-the-art exhibition technology. The exhibition also included Native artifacts and art works to complement the videos, including a scale model of the iconic Hokule’a Native Hawaiian voyaging canoe, and a full-size Lummi Indian healing totem pole. The totem journeyed across the U.S. prior to its installation next to the NLM herbal garden in Bethesda, MD. A traveling version of the exhibition visited more than 130 venues in 40 States across the U.S. The interview clips and other content are accessible on the exhibition website, and the full-length interviews are retained in the NLM permanent video collection.

Self-Determined Health: Reevaluating Current Systems and Funding for Native American Health Care.

For years, the federal government has failed to uphold its promises to provide health care to Native Americans. These promises are echoed in treaties, the Constitution, and judicially-created law. As a result of this breach of promise and chronically underfunding, there are significant health disparities between indigenous populations and other Americans. In a recent 2020 case, McGirt v. Oklahoma, the U.S. Supreme Court held that both the federal government and individual states must follow the terms of a treaty made with a tribe, encouraging the possibility of direct health care funding. This reform, however, means little without tribal sovereignty and self-determination, which give dignity and decisionmaking capabilities back to a group that has long been without them. This Note explores two examples of self-determination in Native American health care, the Alaskan Native health care system and the recent vaccine rollout, proposing a framework for increasing self-determination in health care to provide support for funding reform, which becomes increasingly necessary as Native Americans continue to struggle to access health care.

Engaging Native American High School Students in Public Health Career Preparation Through the Indigenous Summer Enhancement Program.

Native American1 populations are systematically marginalized in the healthcare and public health workforce. One effective approach to reduce health disparities and improve health care delivery among Indigenous populations is to train more Native American health professionals who integrate academic and cultural knowledge to understand and influence health behaviors and perspectives. Diné College partnered with Northern Arizona University to develop the Navajo Native American Research Center for Health (NARCH) Partnership, funded by the National Institutes of Health. The high school component of the Navajo NARCH Partnership created the Indigenous Summer Enhancement Program (ISEP), a 1-week summer training program providing exposure to health careers and mentorship in pursuing public health careers for Native American high school students. ISEP utilizes the Diné Educational Philosophy (DEP), a Navajo conceptual framework to serve as the foundation of the program. In 2020–2021, due to COVID-19 restrictions, the DEP model had to be incorporated in the Navajo NARCH high school virtual program activities. ISEP used 2018 and 2019 past program evaluation data to inform the virtual programming. Students' perception of the program was collected using an online Qualtrics evaluation questionnaire. Students stated appreciation for program staff, fellow students, peer mentors and culturally relevant learning experiences in both virtual and in-person environments. Recommendations included: expanding the length of ISEP and continuing the hands-on activities and Public Health Leadership series.

Native Voices Exhibition: Stories of Health, Wellness, and Illness from American Indians, Alaska Natives, and Native Hawaiians.

The U.S. National Library of Medicine (NLM) exhibition known as Native Voices reflected Donald A.B. Lindberg M.D.'s keen and long-held desire to help improve public understanding of Native American health challenges and honor the culture, tradition, and healing ways of Native Peoples. A centerpiece of the exhibition was a large set of video interviews that Dr. Lindberg conducted with Native health and community leaders. Dr. Lindberg and his team engaged Native advisors in the exhibition development; sought Native input through Listening Circles, Tribal Consultations; and site visits, and made the video interviews accessible via interactive kiosks and iPads. For its time, this was state-of-the-art exhibition technology. The exhibition also included Native artifacts and art works to complement the videos, including a scale model of the iconic Hokule'a Native Hawaiian voyaging canoe, and a full-size Lummi Indian Healing Totem Pole. The totem journeyed across the U.S. prior to its installation next to the NLM herbal garden in Bethesda, MD. A traveling version of the exhibition visited more than 130 venues in 40 States across the U.S. The interview clips and other content are accessible on the exhibition website, and the full-length interviews are retained in the NLM permanent video collection.

Laura Hammitt—prioritising Native American health

As a young girl, Laura Hammitt was able to see different parts of the USA, including remote Alaska, thanks to her father's work as a mineral exploration geologist. These experiences included meeting Alaska Native families with whom her dad worked, yet she did not know then how Indigenous communities were to become a major focus of her career.

Increasing Funding for the Indian Health Service to Improve Native American Health Outcomes

Increasing Funding for the Indian Health Service to Improve Native American Health Outcomes

Reducing Poverty to Improve Native American Health Outcomes

Reducing Poverty to Improve Native American Health Outcomes

Tribal Perspectives on Hypertension: Results From the Center for Native American Health Native-CHART Needs Assessment.

American Indian/Alaska Native (AI/AN) hypertension contributes to cardiovascular disease, the leading cause of premature death in this population. The purpose of this article is to document strategies, concerns, and barriers related to hypertension and cardiovascular disease from Native-Controlling Hypertension and Risks through Technology (Native-CHART) symposiums facilitated by the Center for Native American Health (CNAH). The objectives of this evaluation were to combine Health Needs Assessment (HNA) data and explore barriers and strategies related to hypertension while assessing changes in participants' perspectives over time (2017-2021). CNAH followed an iterative process each year for planning the HNA, facilitating the HNA, and refining and reflecting on HNA findings over time. This involved 3 interconnected steps: (1) developing a shared understanding for the HNA, "Why are we here?," (2) facilitating the HNA during annual symposiums "What do we do?," and (3) reflecting on "What did we learn?". Data were collected using a culturally centered HNA co-created by the CNAH team and tribal partners. Qualitative data analysis utilized a culturally centered thematic approach and NVivo software version 12.0. Quantitative data analysis included summarizing frequency counts and descriptive statistics using Microsoft Excel. Over the 5-year period, 212 Native-CHART symposium participants completed HNAs. Data collected from HNAs show persistent barriers and concerns and illuminate potential strategies to address AI/AN hypertension. Future efforts must explore effective strategies that build on community strengths, culture and traditions, and existing resources. This is the path forward. CNAH's culturally centered and unique HNA approach helped assess participant perspectives over time. CNAH facilitated symposiums over multiple years, even amid a global pandemic. This demonstrates resilience and continuity of community outreach when it is needed the most. Other universities and tribal partners could benefit from this iterative approach as they work to design HNAs with tribal populations.