Alaska Research Articles

Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations.

Adherence to the Mediterranean diet has been shown to lower the risk of developing chronic non-communicable diseases like cardiovascular and neurodegenerative diseases and cancer. Improvements in depression, participation in daily activities in older individuals, weight loss and a reduction in adverse pregnancy outcomes are associated with adherence to the Mediterranean diet. The number of studies that have evaluated barriers to adherence to the Mediterranean diet in the US and, in particular, in racial and ethnic minority populations within the US are few. Among Native American and Alaskan Native populations, studies evaluating traditional or alternative Mediterranean diet adherence for chronic non-infectious diseases is unavailable. Mediterranean diet scoring instruments used in studies in European and Mediterranean countries and among white participants in the US fail to capture the dietary patterns of racial and ethnic minority populations. In this narrative review, the food components of the traditional Mediterranean diet are discussed, adherence to the Mediterranean diet is examined in Mediterranean and non-Mediterranean countries and barriers preventing adherence to the Mediterranean diet in the US and among racial and ethnic minority populations is reviewed. Recommendations for improving nutrition education and intervention and for increasing adherence and cultural adaptions to the Mediterranean diet are provided.

Anatomical and demographic prognosticators of pancreatic cancer.

e16310 Background: Pancreatic cancer is known to have one of the poorest median of survival (mOS) of all cancers. It is now the third leading cause of cancer-related mortality after lung & colorectal cancer. With the current trends, understanding & knowing prognosticators can aid in determining outcomes of pancreatic cancer. Methods: The data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2022 Sub (2000-2020). We extracted pancreatic cancer cases based on primary site encoding for head, body & tail of pancreas, Islets of Langerhans (IoL), other specified parts & overlapping lesion of pancreas, pancreas, NOS (no other specific). The analysis was further completed by comparing survival using the Log-rank test (GraphPad Prism). Results: A total of 221,304 cases were extracted between 2000-2020. The median age of diagnosis was 71 years. 50.54% were males, & 49.45% were females. The incidence rates are shown below. Whites (69.99%) were commonly affected, followed by Blacks (11.05%), Hispanics (10.79%), Asians & Pacific islanders (7.41%), Alaskan natives & American-Indians (0.57%). A distribution in anatomy was notable for head of the pancreas (46.00%), followed by tail (13.20%), body (11.34%), pancreatic duct (0.49%), IoL (0.10%). A survival curves were compared on different variables. Gender showed no statistical difference. mOS for patients diagnosed >70 years was 3 months & <70 years was 8 months (p value <0.0001, CI 0.3716 to 0.3784, HR 1.731). mOS for calculated for Whites (5), Blacks (4), Asian & Pacific islanders (6), Alaskan natives & American-Indians (4), & hispanics (5) (p value <0.0001). mOS based on involved parts of pancreas were compared for: head (6), body (6), tail (5), pancreatic duct (8), IoL (59) (p <0.0001). Conclusions: Median age of diagnosis was in 71, with a slight male predilection. Overall incidence rate is trending up. It is significantly higher for males, & is significantly lower for females than that of the general population. Whites are most commonly affected, & Alaskan natives & American natives are rarely affected. Survival is significantly greater if diagnosed <70 years. Most common site involved is the head of pancreas, & the least is IoL. mOS is ~10 times greater for IoL, but it's an endocrine pancreatic cancer which is treated differently. From the exocrine pancreas, survival is the best for pancreatic duct cancer, & the worst for pancreatic duct. If anatomic & demographic prognosticators are combined with molecular, radiologic factors, it can be beneficial in predicting the outcomes of this cancer with poor prognosis. [Table: see text]

Epidemiology of mast cell leukemia: A must!

e18537 Background: Mast Cell Leukemia (MCL) is one of the rarest encountered malignancies. It is an aggressive oncologic subtype of systemic mastocytosis (SM) and accounts for <1% of total cases. To make the diagnosis of MCL, in addition to the diagnostic criteria for SM (enlisted in the table), ≥ 20% atypical mast cells should be present in the marrow or ≥ 10% in the peripheral blood. However, an aleukemic form also exists. It can either occur as a de novo mutation or follow mastocytosis. The aim of this epidemiologic study is to aid better understanding of this lesser known aggressive malignancy. Methods: The data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2022 Sub (2000-2020). We extracted Systemic Mastocytosis and Mast Cell Leukemia cases diagnosed after 20 years of age, using the ICD Code 9741/3 (SM) and 9742/3 Mast Cell Leukemia (MCL). The analysis was stratified for MCL based on age, sex, race, and treatment modality used. Results: A total of 795 cases of SM were identified, which were diagnosed between 2000 and 2020. Of which, only 35 cases were attributed to MCL over the last two decades. Of these 35 cases, 60% patients were males, and 40% were females. ~82.85% were Caucasians, ~11.42% were African-Americans, ~2.85% belonged to Asians and Pacific Islanders, and ~2.85% belonged to the Hispanic population. No reported cases were found amongst Alaskan Natives. Further analysis based on survival, gender and races was not done, due to small sample size. Conclusions: MCL accounts for only about 4% of total SM cases. Only 35 cases were identified in the past twenty years, making it one of the rarest encountered malignancies. From the reported data, it was slightly inclined to have male predilection, and Caucasians were the most commonly impacted individuals. Given its extremely low incidence, more research and analysis is warranted to understand this lesser known malignancy. [Table: see text]

Epidemiology of undifferentiated sarcomas: A rare entity.

e23571 Background: Undifferentiated Sarcomas (USar), previously known as malignant fibrous histiocytomas, are a group of rare and diverse malignant tumors of mesenchymal origin with a prevalence of 0.08-1 per 100,000. These are aggressive tumors with often high-grade morphology. The diagnosis is made by exclusion of other sarcoma entities upon bone marrow biopsy (criteria listed below). Undifferentiated sarcomas are of four major types, i.e. Pleomorphic, Epithelioid, spindle and round cells. The exact etiology of these sarcomas remains obscure, although many signaling pathways with various genetic alterations may be implicated in their development. The goal of this epidemiologic study is to assist in better understanding of this lesser known aggressive malignancy. Methods: The data was collected from Surveillance, Epidemiology and End Result database Research Plus Data, 17 Registries, Nov 2022 Sub (2000-2020). We extracted undifferentiated sarcoma cases diagnosed between 0-90 years of age, using the ICD Code 8805/3. The analysis was stratified age, gender, race, & primary site labeled. The analysis was further completed by comparing survival using the Log-rank test (GraphPad Prism). Results: A total of 1680 cases of USar were identified, which were diagnosed between 2000 and 2020. Median age of diagnosis was 59.5 years. 50.54% were males and 49.46% were females. Of these cases, ~64.05% were Caucasians, ~15.18% Hispanics, ~10.48% Asians or Pacific Islanders, ~9.35% Black, and < 1% were Alaskan natives/American Indian and Non-Hispanics of unknown race. Further survival curves were compared based on gender, race and organ system. The average months of survival (MoS) based on gender showed no statistical significance (p value 0.6077). MoS calculated for Whites (28), Blacks (16), Asian & Pacific islanders (1), Alaskan natives & American-Indians (15), & Hispanics (21) (p value < 0.0001). MoS based on involved organ system were compared for: head/face/neck (18), GI tract (10), respiratory tract (4), heart/mediastinum/pleura (9), skin & soft tissue (51), bone (32), breast (30), GU (19), CNS (26), gynecological tract (12) and male reproductive system (29) (p < 0.0001). Conclusions: Undifferentiated Sarcoma accounts for less than 1% of all adult tumors. Only 1680 cases were found in the past twenty years, rendering it one of the rarest seen malignancies. Of the reported data, USar was most commonly observed in Caucasians. Comparing the survival curves also showed that there was no difference in survival based on gender. The highest MoS was seen in undifferentiated sarcomas of skin and soft tissues while respiratory tract tumors had the lowest average survival time. More research and analysis is warranted to understand this lesser known malignancy given its extremely low incidence.

Differences in shared decision-making and prostate cancer screening by sexual orientation and race/ethnicity.

10525 Background: There are well-documented disparities among racial and sexual minorities in prostate cancer screening uptake and shared-decision making (SDM) conversations. However, it is unclear how racial/ethnic identity and sexual orientation interact to affect prostate-specific antigen (PSA) testing uptake. Methods: Data came from the 2018-2022 Behavioral Risk Factor Surveillance Survey (BRFSS). Outcomes were survey responses to questions about engagement in SDM and PSA testing uptake. The sample included 88,365 heterosexual (HS) men and 2,562 sexual minority (SM) men ages 55 to 69. Data were stratified by race/ethnicity and survey-weighted logistic regression models analyzed the association between sexual orientation and outcomes. Models controlled for age, relationship status, education, household income, insurance status, having a usual source of care, and region. Results: White SM men were more likely to have discussed disadvantages of PSA testing with their healthcare provider [odds ratio (OR)=1.407; p<0.001] and to have undergone PSA testing [OR=1.320; p<0.001] compared to White HS men. Asian SM men were more likely to have had discussions about PSA testing [OR=4.470; p<0.05]; to have discussed advantages [OR=4.596; p<0.05]; to have been recommended PSA testing [OR=4.836; p<0.05] and to have undergone PSA testing [OR=4.401; p<0.001] compared to Asian HS men. Black SM men were more likely to undergo screening because of an issue or a reason besides routine screening [OR=1.073, p<0.05] compared with Black HS men. Hispanic SM men were more likely to have undergone screening as part of a routine checkup [OR=4.2, p<0.001] compared with Hispanic HS men. There were no sexual orientation differences in PSA screening or SDM among American Indian or Native Alaskans. Conclusions: Differences in PSA testing uptake and SDM by sexual orientation vary by race/ethnicity. Further research is needed to study the factors affecting PSA testing uptake and SDM among sexual minority men of different racial/ethnic groups. [Table: see text]

Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990-2022.

Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. We used data from the 1990-2022 National Vital Statistics System, 2015-2022 American Community Survey, and the 2018-2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.

Indian Preference and the status of American Indians and Alaska Natives in the federal service: Employment, earnings, authority, and perceptions of fairness

AbstractPublic administration scholars have largely ignored American Indians and Alaska Natives in their studies of racial disparities in the federal service, despite strong reasons to believe they face discrimination. Using three large federal data sets (the American Community Survey, federal personnel records, and the Federal Employee Viewpoint Survey), we compare the status of American Indians and Alaska Natives in the federal service to both Whites and other minorities. We find that, largely due to Indian Preference, American Indians and Alaska Natives are much more likely than Blacks, Whites, Latinos, and Asians to hold federal jobs, but they are highly concentrated in the Bureau of Indian Affairs and the Indian Health Service, agencies with which they have a sordid and fraught history. This concentration allows them to work in positions that may advance the interests of their communities and increases their probabilities of being supervisors, but it does not prevent them from being among the poorest‐paid and least‐satisfied employees in the federal service.

Trends and disparities in cardiac implantable electronic device infection-related mortality in the United States.

We performed a cross-sectional study using the Centers for Disease Control and Prevention's (CDC's) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to analyze the trends in cardiac implantable electronic device (CIED) infection-related mortality from 1999 to 2020. We analyzed the death certificate data from the CDC WONDER database from 1999 to 2020 for CIED infections in the US population aged ≥25 years usingInternational Classification of Diseases, Tenth Revision(ICD-10) codes, listed as the underlying or contributing cause of death. Age-adjusted mortality rates (AAMR) and 95% confidence intervals (CIs) were computed per 1 million population by standardizing crude mortality rates to the 2000 US census population. To assess annual mortality trends, we employed the Joinpoint regression model, calculating the annual percent change (APC) in AAMR and corresponding 95% CIs. Overall, there was an observed declining trend in AAMRs related to CIED infection-related mortality. Males accounted for 55% of the total deaths, with persistently higher AAMRs compared to females over the study duration. Both males and females had an overall decreasing trend in AAMRs throughout the study duration. On race/ethnicity stratified analysis, non-Hispanic (NH) Blacks exhibited the highest overall AAMR, followed by NH American Indians or Alaska Natives, NH Whites, Hispanic or Latinos, and NH Asian or Pacific Islanders. On a stratified analysis based on region, the South region had the highest overall AAMR, followed by the Midwest, West, and Northeast regions. Our study demonstrates a significant decline in CIED infection-related mortality in patients over the last two decades. Notable gender, racial/ethnic, and regional differences exist in the rates of mortality related to CIED infections.

American Indian and Alaska Native recruitment strategies for health-related randomized controlled trials: A scoping review.

Significant health disparities exist among American Indian and Alaska Natives (AI/ANs), yet AI/ANs are substantially underrepresented within health-related research, including randomized controlled trials (RCTs). Although research has previously charted representation inequities, there is however a gap in the literature documenting best practice for recruitment techniques of AI/ANs into RCTs. Therefore, the aim of this review was to systematically gather and analyze the published literature to identify common strategies for AI/AN participant recruitment for RCTs in the US. A scoping review methodology was engaged with a systematic search operationalized within relevant databases to February 19, 2022, with an additional updated search being carried out up until January 1, 2023: PubMed, Embase, Web of Science, PsycINFO, CINAHL, and Google Scholar. A two-stage article review process was engaged with double reviewers using Covidence review software. Content analysis was then carried out within the included articles by two reviewers using NVivo software to identify common categories within the data on the topic area. Our review identified forty-one relevant articles with the main categories of recruitment strategies being: 1) recruitment methods for AI/ANs into RCTs (passive advertising recruitment approaches, individual-level recruitment approaches, relational methods of recruitment); 2) recruitment personnel used within RCTs; and, 3) relevant recruitment setting. The majority of the included studies used a culturally relevant intervention, as well as a community-involved approach to operationalizing the research. Increasing AI/AN representation in RCTs is essential for generating evidence-based interventions that effectively address health disparities and improve health outcomes. Researchers and funding agencies should prioritize the engagement, inclusion, and leadership of AI/AN communities throughout the RCT research process. This includes early community involvement in study design, implementation of culturally tailored recruitment strategies, and dissemination of research findings in formats accessible to AI/AN communities.

Developing semiochemical repellents for protecting Picea from Dendroctonus rufipennis (Coleoptera: Curculionidae) in Alaska and Utah, USA.

Spruce beetle, Dendroctonus rufipennis (Kirby) (Coleoptera: Curculionidae), is the most destructive pest of mature spruce (Picea) in western North America. Recent outbreaks in Alaska and other western US states highlight the need for tools to protect Picea from D. rufipennis. The primary antiaggregation pheromone of D. rufipennis (3-methylcyclohex-2-en-1-one, MCH) and various combinations of potential repellents (1-octen-3-ol, exo-brevicomin, endo-brevicomin, ipsdienol, ipsenol, limonene, and verbenone) were tested for their ability to disrupt the response of D. rufipennis to attractant-baited multiple-funnel traps. Two assays were conducted on the Kenai Peninsula, Alaska, in June and July 2021. All treatments significantly reduced the mean number of D. rufipennis caught compared to the baited control. No other significant differences were observed among treatments. Informed by these and other data, tree protection studies were established in Lutz spruce, Picea × lutzii, on the Kenai Peninsula in 2022 and in Engelmann spruce, Pi. engelmannii, in the Uinta Mountains, Utah, in 2021. All experimental trees were baited with frontalin. Repellent treatments included MCH (SPLAT MCH, ISCA Inc., Riverside, CA, USA) and at least 1 additional repellent combination. In Alaska, all treatments significantly reduced colonization (strip attacks + mass attacks) and mortality of individually treated Pi. × lutzii and all Picea within 11.3-m radius of each treated Pi. × lutzii compared to the control. In Utah, all treatments except for SPLAT MCH + octenol significantly reduced colonization compared to the control. Only SPLAT MCH + Acer kairomone blend (AKB) and SPLAT MCH + octenol reduced Pi. engelmannii mortality compared to the control. SPLAT MCH + AKB and SPLAT MCH + acetophenone and green leaf volatiles (PLUS) were the most effective across both studies. The implications of these and other results to the development of an effective semiochemical repellent for D. rufipennis are discussed.

Neurological Care within the Indian Health Service.

American Indians and Alaska Natives (AI/AN) are the Indigenous peoples of the United States. According to the U.S. Census Bureau, approximately 9.7 million people self-identified as AI/AN (alone or in combination with other races), representing 2.9% of the total U.S. population. These people represent diverse groups of discrete Tribes, each with their language, culture, and geographic home. As part of the conquest and settlement of North America, some Indigenous peoples signed treaties with the U.S. government, surrendering their lands in return for various government commitments, including health care. The Indian Health Service (IHS) was born out of these agreements. The IHS is an agency in the U.S. Department of Health and Human Services under the U.S. Public Health Service. The IHS provides a comprehensive health service delivery system for approximately 2.7 million AI/AN who belong to 574 federally recognized Tribes/nations in 37 states. The aim of this paper is to make recommendations regarding the initiation of sustainable neurology care in marginalized or underserved populations by reviewing 40 years of neurology care provision within the IHS. We will discuss (1) the IHS, (2) neurological care provided within the IHS, including midlevel provider extension of neurology care and traditional medical care, and (3) select neurological diagnoses within AI/AN populations. Marginalized populations, including those in the United States that are rural, remote, or low socioeconomic status, lack access to specialty neurology care. This includes many AI/AN. The IHS has developed novel solutions to promote specialty care, including neurology. Notably, initial IHS investments in full-time neurology providers have led to more robust neurology care, often receiving attention from university programs. This suggests that an initial investment in stable on-site full-time neurology services provides a path to potential sustainable care for marginalized populations.

The origin, connectivity, and individual specialization of island wolves after deer extirpation.

Wolves are assumed to be ungulate obligates, however, a recently described pack on Pleasant Island, Alaska USA, is persisting on sea otters and other marine resources without ungulate prey, violating this long-held assumption. We address questions about these wolves regarding their origin and fate, degree of isolation, risk of inbreeding depression, and diet specialization by individual and sex. We applied DNA metabarcoding and genotyping by amplicon sequencing using 957 scats collected from 2016 to 2022, and reduced representation sequencing of tissue samples to establish a detailed understanding of Pleasant Island wolf ecology and compare them with adjacent mainland wolves. Dietary overlap was higher among individual wolves on Pleasant Island (Pianka's index mean 0.95 ± 0.03) compared to mainland wolves (0.70 ± 0.21). The individual diets of island wolves were dominated by sea otter, ranging from 40.6% to 63.2% weighted percent of occurrence (wPOO) (mean 55.5 ± 8.7). In contrast, individual mainland wolves primarily fed on ungulates (42.2 ± 21.3) or voles during a population outbreak (31.2 ± 23.2). We traced the origin of the Pleasant Island pack to a mainland pair that colonized around 2013 and produced several litters. After this breeding pair was killed, their female offspring and an immigrant male became the new breeders in 2019. We detected 20 individuals of which 8 (40%) were trapped and killed while two died of natural causes during the 6-year study. Except for the new breeding male, the pedigree analysis and genotype results showed no additional movement to or from the island, indicating limited dispersal but no evidence of inbreeding. Our findings suggest wolves exhibit more flexible foraging behavior than previously believed, and hunting strategies can substantially differ between individuals within or between packs. Nevertheless, anthropogenic and natural mortality combined with limited connectivity to the mainland may inhibit the continued persistence of Pleasant Island wolves.

Some Observations from a Summer Trip to Alaska

Last summer my wife and I went to Alaska for a couple of weeks. In my nearly 40 years of work with the U.S. Fish and Wildlife Service I never had the opportunity to experience Alaska’s wetlands, so I had to do it in retirement — one item on my bucket list. We started our trip in Anchorage and our first stop with the rental car was Potter Marsh which has a great boardwalk system traversing the marsh. To our surprise after walking just 100 yards, we saw a moose feeding in the shallow water...what a sight at our first stop. We then went to Seward and along the way stopped at the Alaska Wildlife Conservation Center and Exit Glacier. When back in Anchorage we stopped at 49th State Brewing where I had two pints of a delicious imperial stout — “Candy Bar” — brewed with peanuts, chocolate, and caramel...perfect for my sweet tooth (sorry but the beer was just so good I have to give it a shout-out). We also visited a high school classmate who was a teacher in Anchorage and spent a day in Talkeetna where we spoke with Aurora Dora, a local photographer who has captured some amazing images of the Aurora Borealis (check out images on her website: https://auroradora.com/). Here we also sampled some birch syrup made from White or Paper Birch (Betula papyrifera var. humilis and B. neoalaskana). On Day 3 we began our Princess land-sea cruise tour as we headed north to Denali for a couple of days and then took the scenic train to Whittier (great views of Alaska’s wetlands on the way, despite the rain) and then to various ports via ship. I was hoping to see some bears in Denali and other places, but the salmon were not yet running, so bears were out of sight although I did see one running across a meadow at some distance. I also saw a few along with other animals common to the state at the Alaska Wildlife Conservation Center where they rescue injured/orphaned wildlife. Some high points of the trip were seeing Denali in all its glory, a female moose with calf at Horseshoe Lake, wildflowers in bloom along the Savage River Trail and the Savage Alpine Trail (exhausting but great time for wildflower photography), a hike across a local bog at Hoonah (Icy Strait Point), a hike through a temperate rain forest (Tongass National Forest) to Mendenhall Glacier, and seeing Humpback Whales (Megaptera novaeangliae) bubblenet feeding in Auke Bay, plus views of a few other glaciers and whales during the cruise. If you don’t know what bubble-net feeding is ... check out this website: https:// www.youtube.com/watch?v=z00G0RxeSP0. There’s still more to see in Alaska, so we’ll probably be heading back in late summer 2025 to travel inland. Here’s some mostly wetland-centric images from the trip.

Visiting with Elders—Aging, Caregiving, and Planning for Future Generations of American Indians and Alaska Natives

(1) Background: To address the importance of engaging American Indian and Alaska Native Elders in a dialogue about healthy aging and fill the gap in the scholarly literature on this topic. (2) Methods: This study conducted a listening session with Elders who attended the 2021 National Indian Council on Aging (NICOA) Annual Conference in Reno, Nevada. The listening session was audio-recorded and transcribed for thematic analysis by two analysts. (3) Results: Important insights regarding American Indian and Alaska Native Elders’ perspectives on planning for future care and aging-related diseases, such as Alzheimer’s disease. (4) Conclusions: This study is one of the first to engage American Indian and Alaska Native Elders in a conversation about health aging. Calls for intergenerational solidarity, protection of Elders, education, and relationality were found to be important themes.

Rural Native Veterans' Perceptions of Care in the Context of Navigator Program Development.

American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans. We describe formative work aimed at understanding and addressing barriers to VHA care from the perspective of rural Native Veterans and those who facilitate their care. Thirty-four individuals participated in semi-structured interviews (22 Veterans, 6 family members, and 6 Veteran advocates) drawn from 9 tribal communities across the US. Participants described many barriers to using the VHA, including perceptions of care scarcity, long travel distances to the VHA, high travel costs, and bureaucratic barriers including poor customer service, scheduling issues, and long waits for appointments. Many Veterans preferred IHS/tribal health care over the VHA due to its proximity, simplicity, ease of use, and quality. Rural Native Veterans must see a clear benefit to using the VHA given the many obstacles to its use. Veteran recommendations for addressing barriers to VHA care within a navigation program include assistance enrolling in, scheduling, and navigating VHA systems; paperwork assistance; cost reimbursement; and care coordination with the IHS/tribal health care.

Promoting diverse perspectives: Addressing health disparities related to Alzheimer's and all dementias.

Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participantsare primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online andconsisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussionsfocused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.

Vaccine safety beliefs in the state of Alaska

ObjectivesIdentifying the key factors associated with vaccine hesitancy remains a challenge as has been highlighted throughout the COVID-19 vaccine roll out and pandemic. The aim of this study was to determine characteristics associated with vaccine safety and compare perceived safety by vaccine. Our hypothesis is that vaccine safety perception will vary by vaccine with COVID-19 as ranked lowest for safety. Study designCross sectional. MethodsA statewide sample (n = 1024) responded to an online 28-point questionnaire via anonymous linked invitation. ResultsAmong the eight vaccines assessed, COVID-19 had the lowest perceived safety (53.13%) followed by human papillomavirus HPV (63.38%). A binomial logistic regression assessed COVID-19 vaccine safety beliefs (safe v not safe) finding age, political orientation, and perceived safety of certain vaccines as statistically significant. As age increased by year, vaccine safety beliefs increased. Persons who identified as conservative demonstrated less belief in vaccine safety than all other groups. Among persons who did not perceive the COVID-19 vaccine as safe, 65.8% believed chicken pox was safe, 63.3% and 61.1% perceived hepatitis A& B were safe. ConclusionsThese findings demonstrate that vaccine safety beliefs differ by vaccine and that persons who do not believe in the safety of the COVID-19 are not exclusively against all vaccines. Understanding factors that increase vaccine safety by vaccine could assist in developing an intervention which could increase belief in safety for all vaccines.

How Education Shapes Indigenous Health Inequalities in the USA and Mexico.

Indigenous peoples around the world face significant health disparities relative to the dominant groups in their countries, yet the magnitude and patterns of health disparities vary across countries. We use data from the National Health Interview Survey and Mexican Family Life Survey to examine the health of Indigenous peoples in Mexico and American Indians and Alaska Natives in the USA and to evaluate how they fare relative to the majority populations in their countries (non-Indigenous Mexicans and non-Hispanic Whites, respectively). We assess disparities in self-rated health and activity limitations, with a focus on how Indigenous health disparities intersect with educational gradients in health. Regression analyses reveal three primary findings. First, Indigenous health disparities are larger in the USA than in Mexico. Second, differences in educational attainment account for most of the differences between Indigenous and non-Indigenous populations in Mexico, but less than half in the USA. Third, in both countries, health is moderated by educational attainment such that between-group disparities are largest at the highest levels of education. However, for Indigenous Mexicans there is a "cross-over" in which Indigenous Mexicans report better health at the lowest level of education. Overall, this study finds a weak relationship between education and Indigenous health, and raises the question about the validity of using traditional measures of SES in Indigenous contexts.

No Stone Unturned

A prefatory note from the editorial collective. When the Society for Cultural Anthropology selected our distributed, international editorial collective to lead Cultural Anthropology, they did so in part to support our commitment to opening channels of this crucial platform of our discipline beyond the scope of privileged, endowed higher educational institutions in the United States. As one step of this process, in this issue we provide space to the Choctaw Nation of Oklahoma to describe their work since the passage of the Native American Graves Protection and Repatriation Act (NAGPRA) in 1990. As Deanna L. Byrd, the NAGPRA Liaison-Coordinator and Research and Outreach Program Manager of the Choctaw Nation of Oklahoma, and Ian Thompson, the Tribal Historic Preservation Officer of the Choctaw Nation of Oklahoma, writes, since that time, “Native American communities gained a measure of say in how ancestral burials are treated on federal lands. The law also established a mechanism to help Native American, Alaskan, and Native Hawaiian communities have open dialogue with institutions across the country about the return of their ancestors, funerary objects, sacred objects, and objects of cultural patrimony.” Please read the rest of their guest commentary to learn more.

Advancing a WEF nexus security index for Alaska: an informed starting point for policy making

ABSTRACT Water, energy, and food (WEF) security has become a key area of research in sustainable development. Prompted by the United Nations’ Sustainable Development Goals, a large body of research highlights the inter-connectedness of WEF systems and the dangers of their siloed treatment. Simultaneously, more attention is being placed on the WEF security of remote populations in the Arctic, especially for areas like Alaska, where WEF insecurities are prevalent, yet obscured by national reporting. This research developed a WEF Nexus Security Index for the state of Alaska that can be used by policy-makers to consider plausible causes for regional inequalities and why some regions of Alaska, and not others are exposed to higher levels of WEF insecurity. Beyond the conceptual value of the index, an on-line Arctic WEF Nexus Security portal was developed that further enables policy-makers and community leaders to track changes in WEF security and monitor the effects stemming from future interventions, be they policy or technological in nature. By bridging nexus thinking and nexus doing, we hope to provide policy-makers with a novel and accessible tool for achieving WEF security in Alaska.