Rural Native American Research Articles

Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities.

Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. Overall, 63% of participants (n=268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.

Rural–nonrural divide in car access and unmet travel need in the United States

AbstractCar access is practically a necessity to get around in rural areas of the United States. Yet approximately 4% of rural residents or 4.3 million people do not have a car. Despite important rural–nonrural differences in the built environment and how people travel, research on rural mobility disparities by car access is limited. This paper addresses this gap by asking and answering the following questions: (1) What are the scope and scale of rural car access in the U.S. and what are the factors associated with not having a car? (2) How do rural carless residents get around relative to their nonrural peers? (3) What are the consequences of not having car access in rural areas? We used a dichotomous rural–nonrural classification to evaluate differences in car access and mobility outcomes between rural and nonrural areas using the U.S. Census Bureau Public Use Microdata Sample and the National Household Travel Survey. The results reveal new evidence on socioeconomic and mobility disparities by car access within and between rural and nonrural areas. Rural carless households earn 64% less and 40% less than their counterparts with full car access and their nonrural counterparts, respectively. Rural Native Americans, Black, and Asian populations have a 2.1 times, 1.3 times, and 1.3 times the odds of being carless, respectively, than their rural white peers, after controlling for other factors. Despite their lack of access to a car, a significantly smaller proportion of rural carless residents bike, walk, or take transit for work trips than their nonrural peers (38.9% vs. 74.6%), which may indicate infeasibility of sustainable modes in some rural areas. Consequently, rural carless residents are 2 times more likely to forsake trips than their nonrural peers due to a lack of transportation options. Our findings highlight rural mobility inequities that carless people face relative to their nonrural peers, which merit attention and tailored policy interventions to improve rural mobility, sustainability, accessibility, and equity.

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

A pragmatic randomized trial of home-based testing for COVID-19 in rural Native American and Latino communities: Protocol for the “Protecting our Communities” study

BackgroundHome-based testing for COVID-19 has potential to reduce existing health care disparities among underserved populations in the United States. However, implementation of home-based tests in these communities may face significant barriers. This study evaluates the acceptability, feasibility, and success of home-based testing and the potential added benefit of active support from trusted community health workers for Native Americans and Hispanic/Latino adults living in rural Montana and Washington states. Methods/designThe academic-community research team designed the trial to be responsive to community needs for understanding barriers and supports to home-based COVID-19 testing. The “Protecting Our Community” study is a two-arm pragmatic randomized controlled trial in which a total of 400 participants are randomized to active or passive arms. Participants of both study arms receive a commercially available home collection COVID-19 test kit, which is completed by mailing a self-collected nasal swab to a central laboratory. The primary study outcome is return of the kit to the central lab within 14 days. The cultural, social, behavioral, and economic barriers to home-based COVID-19 testing are also assessed by qualitative research methods. A survey and semi-structured interviews are conducted after the trial to evaluate perceptions and experience of home-based testing. DiscussionImplementing home-based testing in underserved populations, including among Native American and Hispanic/Latino communities, may require additional support to be successful. The Protecting Our Community trial examines the effect of trusted community health workers on use of home-based testing, which may be adaptable for community-driven models of home-based testing in other underserved populations.

Empowering our people: Predictors of retention in an STI risk reduction program among rural Native Americans with binge substance use.

Substance use and sexual risk-taking have been shown to co-occur. Programs focused on sexually transmitted infections (STIs) reduction may benefit substance-using, particularly binge substance-using, adults. This is especially true for rural Native American communities who endure sexual and substance use disparities and have few STI risk reduction programs. This study explores factors predicting retention in an STI risk reduction program among rural Native adults engaged in binge substance use. We analyzed data from 150 Native adults ages 18-55 participating in an evaluation of "EMPWR," a 2-session STI risk reduction program in a rural, reservation-based community. Multivariate logistic regression models were used to estimate associations between independent variables and program completion across demographics, sexual behaviors, substance use behaviors, mental health, recent health care utilization, and perceived enculturation and discrimination. The sample was 49.2% (n = 59) female with a mean age of 33.61 years (SD = 8.25). Twenty-six completed only the first EMPWR session, 94 completed both EMPWR sessions, and 30 were randomized but completed 0 sessions. Being married/cohabiting (adjusted odds ratio [AOR] = 6.40, P = .0063) and living with an older generation (AOR = 4.86, P = .0058) were significantly associated with higher odds of completing EMPWR. Findings provide insight on factors driving retention of Natives with recent binge substance use in STI risk reduction programming. An important contribution to Native health literature is that living with an older generation positively predicted EMPWR program completion, suggesting that STI risk reduction programs should harness the strength of families to ensure program attendance and optimize impacts in rural reservation contexts.

Development and Validation of a Community Assessment Tool for Diverse Rural Family Caregivers

The aging of the United States population has led to an increase in the prevalence of Alzheimer’s Disease and Related Dementias (ADRD). Many individuals with ADRD receive care from family members and friends who, themselves, experience poor health outcomes. ADRD family caregivers from diverse backgrounds are frequently underserved by health and social service systems. However, research suggests that diverse caregivers possess culturally-based strengths that serve as protective factors against poor outcomes. This presentation reports findings from a study to develop and validate a community assessment of the needs, assets, and resources of rural Latinx and Native American ADRD family caregivers. Initial assessment items were based upon validated measures developed for diverse ADRD and comparable caregiver populations. A Delphi process was used to obtain ratings from a 9-member expert panel (ADRD policy makers, providers, and family caregivers) about the degree to which the assessment was: (1) inclusive of different cultural groups; (2) respectful of cultural values and norms; (3) comprehensive with respect to needs, assets, and resources, and; (4) relevant to the lived experiences of diverse rural caregivers. Experts also provided qualitative feedback about modifying phrases to make the assessment more relevant to diverse respondents, removing sections, and adding items and response options to better reflect rural life. After two formal rounds of review and multiple iterations, between 77% and 100% of experts agreed that all sections of the assessment met criteria. Findings highlight the benefits of a systematic process for developing and validating community assessments for diverse, rural populations.

Sociodemographic and Psychosocial Factors Associated With Diet Quality in 6 Rural Native American Communities

ObjectiveTo identify psychosocial and household environmental factors related to diet quality among Native Americans (NA). DesignAnalysis of baseline data from a community-randomized obesity prevention trial. SettingSix rural NA communities in the Midwest and the Southwestern US. ParticipantsA total of 580 tribal members, aged 18–75 years old (mean 45 years), 74% female, self-identified as the main household food purchaser. Variables MeasuredDiet quality (Healthy Eating Index–2015 [HEI]) was derived from a semiquantitative food frequency questionnaire. Sociodemographic, psychosocial, and home food environment factors were assessed via interviewer-administered questionnaires. AnalysisOne-way ANOVA, linear regression models, and 2-tailed t tests compared HEI scores among sociodemographic categories. Multiple linear regression models assessed the relationship between psychosocial factors, home food environment, and HEI. ResultsPrevalence of obesity was 59%. Mean HEI–2015 score was 49.3 (SD = 8.1). Average HEI scores were 3.0 points lower in smokers than nonsmokers (P < 0.001), and 2.2 points higher in females than males (P < 0.01). Higher self-efficacy (β = 0.97; P < 0.001) and healthier eating intentions (β = 0.78; P < 0.001) were positively associated with HEI. Healthier household food patterns score was associated with higher HEI (β = 0.48; P < 0.01). Conclusions and ImplicationsPsychosocial factors were associated with diet quality, a finding that supports the use of social-cognitive intervention approaches in rural NA communities in the Midwest and Southwest, and warrants evaluation in other locations. There remains a need to elucidate the association between the Food Distribution Program on Indian Reservations and diet quality.

The Unseen Picture: Issues with Health Care, Discrimination, Police and Safety, and Housing Experienced by Native American Populations in Rural America.

PurposeDespite increased national attention to improving rural health, rural Native American populations face unique problems that are often unseen in aggregate research on the rural United States. The objective of this study was to examine rural Native Americans’ experiences with serious problems across domains important to health, using rural Whites as a comparison group.MethodsUsing 2 probability‐based national telephone surveys (2017 and 2019), we examined rural Native American adults’ reported problems in health care, discrimination, police and safety, and housing. We then compared Native American‐White differences in reported problems across domains.FindingsAmong rural Native American adults, 33% reported recent problems accessing health care when they needed it, 28% reported they or family members recently experienced major problems paying for medical bills, and 28% reported recent problems with health care quality. Several Native American‐White differences were reported, including experiencing racial violence (34% vs 5%, P < .001), discrimination in health care (19% vs 3%, P = .003), unfair police treatment (27% vs 5%, P = .002), and major housing problems (48% vs 26%, P < .001).ConclusionsRural Native American adults report ongoing and widespread problems with health care, discrimination, the police, safety, and housing. These findings support many national policy recommendations to improve federal funding and oversight for programs serving Native American populations living in rural areas.

Abstract C132: A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth

Abstract Accelerating the uptake of Human Papillomavirus (HPV) vaccinations is a priority for cancer prevention and an issue for mitigating cancer health disparities particularly among rural youth, both Native American and non-Native. The rate of HPV vaccinations for rural and Native adolescents is markedly lower than urban adolescents. Based on a Memorandum of Collaboration between the UC Davis Comprehensive Cancer Center and Northern Valley Indian Health (NVIH), a tribal health organization serving rural youth; funding from the National Cancer Institute; and the principles of community-based participatory research, we developed a multi-level approach to accelerate the HPV vaccination rates at the NVIH rural clinic in Willows, CA. Ultimately, the goal is to raise the HPV vaccination rates among patients ages 11-17 from the current 27% at this clinic to the Healthy People 2020 goal of 80%. Our presentation documents a year’s relationship-building that includes the intentional input and promising data from multiple levels for launching an accelerated HPV vaccination program, exemplifying the collaboration between NVIH and a NCI Comprehensive Cancer Center. Starting with community outreach and engagement, our multiple levels included provider and staff trainings; and parent workshops. We began by surveying 12 community members on their HPV vaccination knowledge, attitudes, and behaviors and learned that they had low knowledge of the HPV vaccine and stressed the importance of educating both the community as well as parents. We followed with training of 26 clinic providers and 44 staff (participants were from all four of NVIH’s medical clinics). Pre-tests were administered prior to the training and post-tests administered four months later. The training content had 3 objectives: (1) explaining the importance of HPV vaccinations and the rationale for vaccinating at ages 11-12; (2) providing an effective recommendation by clinicians; and (3) providing support to families to decide in favor of HPV vaccination. While there was attrition from pre to post tests, we achieved significant quantitative realignment of the rank order of HPV vaccination (from 3rd to most important) over other vaccinations and increased confidence in their ability to make a strong HPV vaccination recommendation (14% and 6% respectively). Interviews from parents provided insights on their perspectives of HPV vaccination that should be incorporated. Our next steps will be to apply these findings into a multi-pronged HPV vaccination intervention program for rural Native and non-Native adolescents. Citation Format: Julie HT Dang, Duke LeTran, Alexandra Gori, Arzoo Mojadedi, Teresa Martens, Sharon McClure, Inder Wadhwa, Chester Austin, Moon S Chen, Jr. A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C132.

Implementing collaborative care to reduce depression for rural native American/Alaska native people

BackgroundThe purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients.MethodsCollaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience.ResultsThe clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic.ConclusionsThis project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

Now You See It, Now You Don’t: Digital Connectivity in Marginalized Communities

For marginalized communities around the globe, lack of stable Internet access can result in a “digital divide.” The author’s sociotechnical analysis of three marginalized communities—rural Native Americans in the US, Syrian refugees in Jordan, and Congolese refugees in Rwanda—identifies several key contributing factors, including aid agencies’ changing priorities, goals, and political concerns, as well as technological, geographic, and cultural challenges. Through novel insights about these contributing factors of digital divides, the author generates a set of technical, organizational, and policy solutions.

Thinking inside and outside the box: local and national considerations of the Food Distribution Program on Indian Reservations (FDPIR)

The Food Distribution Program on Indian Reservations (FDPIR) provides a monthly box of U.S. Department of Agriculture foods to low-income, rural Native Americans and is a vital component of food security for recipient households. While the origin of government food annuities dates back hundreds of years to treaties between tribes, pueblos, and nations and the United States Government, FDPIR in its current form and function is 40 years old. The FDPIR food package has faced increasing scrutiny in recent years over the quality, nutritional value, and cultural appropriateness of foods included. Using data collected from three Tribes in the Klamath River Basin as well as national institutions that govern FDPIR, we investigate opportunities and challenges of FDPIR to achieve food security for its clientele, and the extent to which integration of traditional foods can enhance Native American food security, food sovereignty and wellbeing. We conclude with a set of policy recommendations on how to improve Native American food security and food sovereignty outcomes for FDPIR clients.

Children’s Play with a Forest Diorama as a Window into Ecological Cognition

ABSTRACTThis study examined the play of 4-year-old children with a forest diorama that included toy representations of plants and animals. To examine the potential role of culture and expertise in diorama play, children from 3 samples participated: rural Native American, urban Native American, and urban non-Native American. Children’s playtime was divided into time segments, which were coded for types of actions and for types of talk. Children from all 3 samples actively engaged with the diorama in both realistic and imaginative play. Furthermore, children from all samples were sensitive to ecological relations. In addition, Native American children talked at least as much as the non-Native American children, a finding that challenges widespread characterizations of Native American children as less talkative and possessing smaller vocabularies. The most striking finding was that Native American children (both urban and rural) were more than twice as likely as non-Native American children to take the perspective of an animal in their play. These results demonstrate the value of dioramas for assessing young children’s biological cognition.

Service learning in sustainable lighting: a field study engaging populations high in rural Native Americans

Abstract- Service learning and sustainable lighting education prepare students for the future and involve them in rural United States communities with high Native American populations. As part of a research grant, faculty developed a service learning curriculum. It taught students how to measure and document existing lighting conditions, including ultraviolet light levels in state-owned historic homes filled with museum artifacts. Students worked under the supervision of museum staff. Students also provided sustainable lighting education to local consumers who were residents of lower income communities. Although study participants consistently ranked incandescent light highest in positive lighting attributes, compact fluorescent light ranked a close second. Student demonstrations of sustainable lighting were integral to consumer education and as a result of these student-led educational sessions, more participants agreed to consider purchasing compact fluorescent lights instead of incandescent bulbs. Thousands of consumers beyond the study participants were reached through exposure at the Environmental Protection Agency National Student Design Expo and a permanently-linked video documentary of the research process.

Feasibility of Remote CT Colonography at Two Rural Native American Medical Centers

Fort Defiance Indian Hospital and Tuba City Regional Health Care Center are two rural hospitals with limited availability of optical colonoscopy (OC) and other methods of colorectal cancer screening. Our goals were to determine whether adequate examinations could be obtained with remote supervision after brief onsite instruction and to share lessons learned in our experience with a remote CT colonography (CTC) screening program. After brief onsite instruction, including performing a CTC examination on a volunteer to train the CT technologists, both sites began performing CTC using standard bowel preparation, fecal tagging, automatic insufflation, and low-dose technique. Studies were transferred to the University of Arizona Hospital for image quality assessment of stool, residual fluid, distention, and interpretation, with reports returned via the teleradiology information system. Clinical follow-up was performed on those patients referred for polypectomy or biopsy. Three hundred twenty-one subjects underwent CTC, including 280 individuals referred for screening examinations (87%). Ninety-two percent of subjects (295/321) had acceptable amounts of residual stool, 91% (293/321) had acceptable levels of fluid, and 92% (294/321) had acceptable distention. Fourteen percent (44/321) of CTC patients had polyps 6 mm or larger in size, with a positive predictive value of 41% for those who subsequently underwent colonoscopy-polypectomy (11/27). CTC can be introduced to rural underserved communities, performed locally, and interpreted remotely with satisfactory performance, thereby increasing colorectal cancer screening capacity. Important aspects of implementation should include technologist training, referring physician education, careful attention to image transmission, and clearly defined methods of communication with patients and referring providers.

Depression Among Rural Native American and European American Grandparents Rearing Their Grandchildren

Increasing numbers of grandparents are rearing their grandchildren because of their adult children's inability to parent. Researchers have begun to document the mental health outcomes of grandparent caregivers in general, yet none have examined the mental health of Native American and European American grandparent caregivers residing in rural communities. To shed light on this topic, the current study examined relationships between degree of rurality; economic, community, and social resources; grandparenting experiences; and depression among 55 rural Native American and European American custodial grandparents. Based on hierarchical regression analyses, the best predictors of depression were grand-parental stress, total time providing primary care to grandchildren, household income, and race. Grandparents experiencing more stress, less time in the role of primary grandparent caregiver, and lower household income reported more depressive symptoms. Moreover, Native American grandparent caregivers reported more depressive symptoms than did their European American counterparts. Implications for research and practice are discussed.

Folkbiological reasoning from a cross-cultural developmental perspective: Early essentialist notions are shaped by cultural beliefs.

In 2 experiments, the authors examined the evolution of folkbiological reasoning in children (4 to 10 years of age) and adults from 4 distinct communities (rural Native American, rural majority culture, and suburban and urban North American communities). Using an adoption paradigm, they examined participants' intuitions regarding the inheritance of properties and the mechanisms underlying the transmission of kindhood. Across all communities and ages, there was a strong biological component underlying reasoning about the inheritance of properties. There were also differences in children's intuitions about the mechanisms underlying kindhood: Native American children were more likely than their counterparts to consider blood as a candidate biological essence. This suggests that as children search to discover the underlying essence of a biological kind, they are guided by broad essentialist notions that are shaped by discourse within their community.

Headliners: Smoking: The Role of the Parent in Deterring Child Smoking, as Seen by Rural Native American and White Parents

Vol. 113, No. 10 EnvironewsOpen AccessHeadliners: Smoking: The Role of the Parent in Deterring Child Smoking, as Seen by Rural Native American and White Parents Jerry Phelps Jerry Phelps Search for more papers by this author Published:1 October 2005https://doi.org/10.1289/ehp.113-a667AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Kegler MC, Malcoe LH. 2005. Anti-smoking socialization beliefs among rural Native American and white parents of young children. Health Educ Res 20(2):175–184.Studies suggest that there are differences between the races in parental “anti-smoking socialization”—that is, how parents influence their children’s expectations regarding the feasibility, acceptability, and consequences of smoking cigarettes. For instance, black parents are more likely than white parents to set ground rules regarding tobacco use for their children, and are less likely to assume that teens will inevitably experiment with smoking. Now Lorraine Halinka Malcoe and NIEHS grantee Michelle C. Kegler of Emory University have compared antismoking socialization beliefs among rural white and Native American parents. Better information on how beliefs vary racially could help shape more effective ways of teaching parents to deter their children from smoking.Teen smoking rates vary significantly between racial and ethnic groups. According to data from the Centers for Disease Control and Prevention for the year 2000, 31.8% of white high school students reported smoking in the past 30 days. Hispanic students were next at 22.6%, followed by Asian Americans at 20.6%, and blacks at 16.8%. Data on smoking among Native American teenagers are not as readily available, but some studies have indicated the rate among Native Americans overall is comparable to or higher than that of whites. In 2000, 36% of adult Native Americans smoked, compared with 24.1% of white adults.The study showed that Native American and white parents were similar in their antismoking socialization beliefs with one exception: Native American parents were less likely to believe that schools are better than parents at teaching children about the dangers of smoking. Less educated parents were more likely to believe that strictly forbidding children to smoke only makes them want to smoke more. Consistent with earlier results, parents of both races had less stringent beliefs and a lesser sense of parental efficacy compared to black parents.Methods to bolster antismoking socialization beliefs of less-educated parents may be important in preventing children in low-income rural communities with high smoking rates from beginning to smoke. Although limited in size and scope, this study provides evidence that future research should focus on ways to increase parental communication of antismoking beliefs and assessment of whether such interventions result in lower rates of smoking onset.FiguresReferencesRelatedDetails Vol. 113, No. 10 October 2005Metrics About Article Metrics Publication History Originally published1 October 2005Published in print1 October 2005 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Religiousness/Spirituality and Subjective Well-Being Among Rural Elderly Whites, African Americans, and Native Americans

SUMMARY Little attention has been paid to subjective well-being among non-White elderly in rural areas where medical resources and financial support are deficient. The present study assessed a rural community sample of 215 elderly comprising 85 Caucasians, 75 African Americans, and 55 Native Americans, to examine roles of spirituality/religiousness on their subjective well-being. This study found ethnic differences in the reliance on religiosity/spirituality and a significant association between dimensions of religiousness/spirituality and subjective well-being among all ethnic rural elderly groups. The results of the study suggest that health providers, social workers, and faith communities need to provide rural elderly with religious and spiritual support in order to enhance their life satisfaction and lessen their emotional distress.

Food Consumption Patterns of Rural Older African American, Native American, and White Adults in North Carolina

This paper describes the major food sources of selected nutrients for an ethnically diverse sample of older adults in rural North Carolina. A representative sample of 130 elders (> 70 years) completed semi-quantitative food frequency questionnaires. Percentages of foods most frequently consumed as the lead source of seven nutrients were calculated overall, by gender and ethnic group. Foods eaten at least one time per week were identified, and percentages of participants consuming that frequency were calculated. Major food sources included: salad oil/cooking oil for calories, total fat and saturated fat; miscellaneous vegetables for dietary fiber and folate; and orange/grapefruit juice for vitamin C. Heterogeneity in food sources was greatest for zinc and least for vitamin C. Variation across gender and ethnic groups was observed only in the degree to which specific food sources contributed to nutrient intake. These data provide greater insight into the dietary patterns of rural elders than examining nutrient intakes.