Urban Indians Research Articles

Household food insecurity and dietary patterns in rural and urban American Indian families with young children

BackgroundHigh food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households.MethodsDyads consisting of an adult caregiver and a child (2–5 years old) from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families.ResultsA high prevalence of food insecurity was determined (61%) and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05). Food insecure adults had significantly lower intake of vegetables (p < 0.05) and higher intakes of fruit juice (<0.001), other sugar-sweetened beverages (p < 0.05), and fried potatoes (p < 0.001) than food secure adults. Food insecure children had significantly higher intakes of fried potatoes (p < 0.05), soda (p = 0.01), and sports drinks (p < 0.05). Focus group participants indicated different strategies were used by urban and rural households to address food insecurity.ConclusionsThe prevalence of food insecurity in American Indian households in our sample is extremely high, and geographic designation may be an important contributing factor. Moreover, food insecurity had a significant negative influence on dietary intake for families. Understanding strategies employed by households may help inform future interventions to address food insecurity.Trial registration (NCT01776255). Registered: January 16, 2013. Date of enrollment: February 6, 2013.

Why urban Indians are interested in an internet based self-care app for depression? a brief pilot survey

Background: Digital technology has emerged as a powerful approach to bridge treatment gap in the field of mental health. However, public health impact of e-interventions is unlikely without large scale uptake of such services. Hence it becomes important to understand motives of potential users in order to design programs that address such needs as well as disseminate information about the same in ways that appeal to the users. Methods: Reasons underlying interest in an internet based self-care program for depression were explored through a brief survey of potential users who had explicitly shown interest in such a program. Responses to an online survey were received from 120 respondents out of which about 69% were in 18-35 years of age-range and 12% were above 50 years of age. Results: Preference for flexibility in terms of ‘when I do things to help myself’, ‘not having time to go for face to face counselling/therapy’ and ‘wanting to learn and do something to prevent problems in future even though I am currently on treatment’ emerged as the top 3 reasons underlying interest in internet based self-help programs for depression. Not having the finances to seek face to face mental health consultation emerged as one of the top 3 reasons in the older group. Conclusions: Incorporating maximal flexibility, providing pointers to the most relevant components thereby minimizing time required, and focusing on preventive strategies (even for those who are currently seeking treatment) are aspects that need to be considered in development and dissemination of internet based self-help programs for depression in urban India.

Perceptions of healthy eating amongst Indian adolescents in India and Canada

IntroductionDietary patterns have contributed to the rising prevalence of overweight and obesity among Indian adolescents. Yet there are limited studies on their perspectives on healthy eating. The purpose of this study was to understand perceptions and attitudes of Indian-origin adolescents in India and Canada that may contribute to healthy eating behaviour. MethodsQualitative data collection and analysis of 13 focus group discussions (FGD) was conducted among 34 boys and 39 girls (total number of participants: 73) of different weight and socioeconomic status (SES) in rural and urban India, and urban Canada aged 11–18 years. ResultsAll adolescents perceived homemade foods, and foods high in vitamins, minerals and fiber as healthy. Rural Indian adolescents also identified contaminant-free food as important. Opinions differed regarding the health value of consuming meat, and amongst Canadian adolescents, the health impact of Western versus Indian diets. Identified benefits of healthy eating included improved energy for Indians, and disease prevention for Canadians and urban Indians. Identified barriers across all settings included peers; and availability, access and affordability of unhealthy foods. Urban Indians and Canadian girls also reported academic stress and lack of time as barriers. Canadian girls reported limited parental supervision during mealtimes as an additional barrier. Facilitators to healthy eating included parents, friends and personal preferences for healthy foods. ConclusionThis study suggests potential targets for family-based and school-based education programs and policies to improve dietary habits of Indian and Indo-Canadian adolescents which include, culturally focused nutrition education and guidelines, academic stress management strategies, parental education, food hygiene regulations and restriction on the sale and advertising of unhealthy foods.

Comparison of Vitamin D Status Between Urban and Rural South Indian Mothers and Their Newborns

Introduction: Though pregnant mothers are at risk of developing Vitamin D deficiency, their level differs among the urban and rural population and has various implications on newborns. This study was undertaken to compare the vitamin D status in urban and rural population of South India among pregnant women and their newborns.Material and Methods: Ninety one pregnant women and their newborns (46 urban and 45 rural) were recruited. Maternal Vitamin D levels and serum concentrations of calcium, phosphorus, alkaline phosphatase and Vitamin D were measured in the cord blood.Results: Eighty two (90%) of the pregnant women, 38 from rural and 44 from urban, had vitamin D deficiency. However, the mean vitamin D levels were low in urban (9.42 ± 12.2) compared to rural women (35.86 ± 16.3,p=0.037).Hypovitaminosis D was noted in 88% of the newborns, deficiency being more in neonates born to urban women. Though the dietary calcium intake was uniformly low, it was lower in rural (960.1 ± 139.9 mg/d) Vs urban mothers (1060.1 ± 150.6 mg/d, p&lt; 0.001). Urban mothers were found to be exposed to sun for lower duration of 0.3 hours compared to rural mothers 0.5 hours. Similarly the surface area of body exposed to sun was lower in urban mothers (7.5%) compared to rural mothers (15%, p=0.0001). A moderate positive correlation between mother-neonate pair was noted.Conclusions: The magnitude of Hypovitaminosis D observed among pregnant women and their newborn warrants public health intervention in terms of vitamin D supplementations during pregnancy.J Nepal Paediatr Soc 2016;36(3):243-249

Review of Urban Indians in a Silver City: Zacatecas Mexico, 1546-1810

Urban Indians in a Silver City: Zacatecas Mexico, 1546-1810, by Dana Velasco Murillo. Stanford University Press, pp. 328, June 2016, ISBN: 9780804796118.

“A Cross Sectional, Observational Study of the Antihypertensive Pharmacotherapeutic Profile in an Urban Indian Adult Population”

“A Cross Sectional, Observational Study of the Antihypertensive Pharmacotherapeutic Profile in an Urban Indian Adult Population”

Human Papillomavirus Vaccine Uptake: Increase for American Indian Adolescents, 2013–2015

Although Indian Health Service, tribally-operated, and urban Indian (I/T/U) healthcare facilities have higher human papillomavirus (HPV) vaccine series initiation and completion rates among adolescent patients aged 13-17 years than the general U.S. population, challenges remain. I/T/U facilities have lower coverage for HPV vaccine first dose compared with coverage for other adolescent vaccines, and HPV vaccine series completion rates are lower than initiation rates. Researchers aimed to assist I/T/U facilities in identifying interventions to increase HPV vaccination series initiation and completion rates. Best practice and intervention I/T/U healthcare facilities were identified based on baseline adolescent HPV vaccine coverage data. Healthcare professionals were interviewed about barriers and facilitators to HPV vaccination. Researchers used responses and evidence-based practices to identify and assist facilities in implementing interventions to increase adolescent HPV vaccine series initiation and completion. Coverage and interview data were collected from June 2013 to June 2015; data were analyzed in 2015. I/T/U healthcare facilities located within five Indian Health Service regions. Interventions included analyzing and providing feedback on facility vaccine coverage data, educating providers about HPV vaccine, expanding access to HPV vaccine, and establishing or expanding reminder recall and education efforts. Impact of evidence-based strategies and best practices to support HPV vaccination. Mean baseline first dose coverage with HPV vaccine at best practice facilities was 78% compared with 46% at intervention facilities. Mean third dose coverage was 48% at best practice facilities versus 19% at intervention facilities. Intervention facilities implemented multiple low-cost, evidence-based strategies and best practices to increase vaccine coverage. At baseline, most facilities used electronic provider reminders, had standing orders in place for administering HPV vaccine, and administered tetanus, diphtheria, and acellular pertussis and HPV vaccines during the same visit. At intervention sites, mean coverage for HPV initiation and completion increased by 24% and 22%, respectively. A tailored multifaceted approach addressing vaccine delivery processes and patient and provider education may increase HPV vaccine coverage.

Abstract A34: Understanding the Predictors of Smoking Cessation in a Culturally Tailored Smoking Cession Program Created for American Indians

Abstract The purpose of this study was to test the effectiveness of the All Nations Breath of Life program (ANBL); a 12-week culturally-tailored smoking cessation program designed for use in a heterogeneous urban and suburban American Indian (AI) population. Through this process we looked at the secondary outcome: predictors of successful smoking cessation. ANBL was developed, implemented, and tested using a community-based participatory research (CBPR) approach in which AI community members were involved in all phases of the research. Participants in ANBL (N=312) self-selected into the study. Participants self-identified as AI (tribal enrollment was not required). Additional inclusion criteria included being 18 years of age or older, cotinine verified current cigarette smoker, self-expressed interest in quitting smoking in the 30 days following the informed consent process. The vast majority of ANBL group sessions were located primarily in the Heartland/Midwest and surrounding areas. ANBL has five primary components, as follows: Group Support Sessions, Individual Telephone Counseling, Educational Curriculum, Pharmacotherapy, and Participant Incentives. The primary endpoint was salivary cotinine verified continuous abstinence at 6-months. Participants were asked to self-report smoking status, “Since your quit date in ANBL, have you ever smoked at least part of a cigarette?” Those participants answering “no” to this question were asked to provide saliva for cotinine verification. At program completion, 53.3% of program completers remained abstinent; using an intent-to-treat analysis labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline, 31.1% of retained participants quit smoking (p&amp;lt;0.0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% using an intent-to-treat analysis (p=0.002). Few items were found to be predictive of ability to quit at the primary endpoint. The most significant predictor of cessation was participation in one of the groups run in Mid-Missouri, all of which were run by one facilitator (OR=0.24, p=0.0005). An additional predictor of cessation included participants who had some form of home smoking rule (partial or full) (OR=0.35, p=0.0004). Other items that approached significance in relationship to quitting included use of traditional tobacco, which negatively impacted quit rates (OR=1.70, p=0.08), having higher self-confidence in one's ability to quit at baseline positively impacted quit rates (OR=2.20, p=0.16), and lack of use of other recreational tobacco products positively impacted quit rates (OR=2.42, p=0.07). Participants who had the longest history of smoking (greater than 20 years) were least likely to quit (OR=0.26; p=0.03). The data found will be incorporated into modifications to the program to assist other participants with successful cessation. Understanding the predictors of smoking cessation can ensure participant success in tailored smoking cession programs. Citation Format: Joseph A. Pacheco, Jordyn Gunville, Nazir Niaman, T. Edward Smith, Sean M. Daley, Won S. Choi, Christine M. Daley. Understanding the Predictors of Smoking Cessation in a Culturally Tailored Smoking Cession Program Created for American Indians. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A34.

Abstract A06: All Nations Breath of Life: A culturally tailored smoking cessation program for heterogeneous urban American Indian communities

Abstract Prevalence of cigarette smoking is highest among American Indians, yet few culturally appropriate smoking cessation programs have yet been developed and tested for multi-tribal American Indian adult populations. This study tested for effectiveness the All Nations Breath of Life culturally tailored smoking cessation program in multi-tribal urban and suburban American Indian communities in 7 locations across 5 states (N=312). This single-arm implementation effectiveness study used community-based participatory research to conduct a 12-week intervention. Participants were followed through month 6 in person and month 12 via telephone. The primary outcome was continuous abstinence from recreational cigarette smoking at 6 months post-baseline, verified through voluntary provision of salivary cotinine levels. At program completion, 53.3% of program completers remained abstinent; using an intent-to-treat analysis labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline, 31.1% of retained participants quit smoking (p&amp;lt;0.0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% using an intent-to-treat analysis (p=0.002). Retention rate at endpoint was 71.2%. 12-month follow-up was attempted with all participants and had a retention rate of 49.0%. Of those participants reached, 34.0% were smoke-free; using an intent-to-treat analysis, the quit rate at 12 months post-baseline was 16.7%. All Nations Breath of Life is an effective smoking cessation program for multi-tribal urban American Indian communities. It can be successfully implemented in a variety of urban settings. Citation Format: Jordyn Gunville, Ryan Goeckenr, Jason Hale, T Edward Smith, Niaman Nazir, Sean Daley, Won Choi, Christine M. Daley. All Nations Breath of Life: A culturally tailored smoking cessation program for heterogeneous urban American Indian communities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A06.

Forging a new path: Urban Indian approaches to service improvement in Ramsey County, Minnesota

Forging a new path: Urban Indian approaches to service improvement in Ramsey County, Minnesota

Metabolic Syndrome in Psoriasis among Urban South Indians: A Case Control Study Using SAM-NCEP Criteria.

Psoriasis is a chronic inflammatory disease of the skin associated with increased cardiovascular morbidity. Metabolic syndrome is a significant forecaster of cardiovascular events. To assess the association of metabolic syndrome and its components in patients with psoriasis and to compare it with the age and sex matched control group. We conducted a hospital based case-control study on 156 adult patients with chronic plaque psoriasis and 156 patients with skin diseases other than psoriasis. Height, weight, BMI, blood pressure and waist circumference were documented in all the subjects. Fasting levels of serum glucose, serum triglycerides and serum HDL were estimated by automated clinical chemistry analyzer. The South Asian modified NCEP ATP criterion was used for the diagnosis of metabolic syndrome. Statistical analysis of the data was done using statistical processing software (SPSS-17). Metabolic syndrome was significantly more common in psoriatic patients than in controls (28.8% vs 16.7%, p=0.01). Hypertriglyceridemia was significantly more prevalent in cases than in controls (34% vs 20.5%, p=0.008). The reduced HDL levels also showed a significantly high occurrence among cases (27.6% vs 13.5%, p=0.002). Moderate increase of blood pressure was seen among cases as compared to controls but the difference was not statistically significant (p=0.1). Impaired blood glucose and abdominal obesity were similar in both groups. Smoking and alcoholism did not influence the association of metabolic syndrome with psoriasis. There was no correlation of metabolic syndrome with severity and duration of psoriasis. Our findings suggest that metabolic syndrome as well as dyslipidemia is common in psoriasis patients among urban South Indians. This study highlights the need for screening at diagnosis and regular follow up of the metabolic aspects of the disease along with the skin lesions.

Residential Substance Abuse Treatment for Urban American Indians and Alaska Natives, Part I: Services and Staff.

Although residential substance abuse treatment is utilized extensively by urban American Indians and Alaska Natives (AI/ANs), there are few detailed descriptions of this care. This study delineated services provided by and interviewed staff working at residential programs designed for chemically dependent urban AI/ANs. Study agencies were compared to national data from residential programs serving general population clients. Study agencies delivered arrays of services substantially broader than those provided by general population programs. As well as culturally specific programs tailored for AI/ANs plus so-called "mainstream" substance abuse treatments, study facilities provided numerous ancillary services, such as care for clients' children.

Residential Substance Abuse Treatment for Urban American Indians and Alaska Natives, Part II: Costs.

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between observed and expected costs. Culturally specific residential substance abuse treatment services can be provided to urban AI/ANs within budgets typically found at mainstream programs.

A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women

ABSTRACT Objective The study tried to analyze the efficacy of levonorgestrel intrauterine system (LNGIUS) for the treatment of heavy menstrual bleeding in the urban and suburban Indian women. Materials and methods The present study was conducted in the Department of Gynecology and Obstetrics, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, over a period of 1 year. A total of 20 patients suffering from abnormal uterine bleeding in the age group of 20 to 45 years were recruited in this study. The LNGIUS was inserted in all the women and they were followed up at the end of 3, 6, and 12 months. All subjects completed 1 year duration of follow-up. We used the Student’s paired t-test to evaluate the reduction in the menstrual blood loss, passage of clots, and increase in hemoglobin concentration at each point from the baseline. Results At the end of 6 months, most (90%) of the women had an acceptable bleeding, with 10% having amenorrhea (pictorial blood-loss assessment chart score 0). Statistically significant improvement in the hemoglobin level was observed at the end of 3, 6, and 12 months postinsertion. The level of satisfaction increased steadily with time. Conclusion Levonorgestrel intrauterine system is an effective reversible treatment for menorrhagia. Levonorgestrel intrauterine system can be used as an effective alternative to hysterectomy in the future in the urban and suburban affluent Indian women. How to cite this article Gupta A, Roychoudhury B, Sanyal P, Chowdhury B, Zoha MMS. A Study to Analyze the Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding among Urban Indian Women. J South Asian Feder Menopause Soc 2017;5(1):19-22.

Tonsillectomy: Patient Response-based Assessment and Results in Urban Indian Population

Tonsillectomy: Patient Response-based Assessment and Results in Urban Indian Population

Medication Adherence in Kidney Transplant Recipients in an Urban Indian Setting.

Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h) more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector (P < 0.001). Nonadherence with other medication was around 19% in both the sectors. Several potential demographic, socioeconomic and psychosocial determinants of nonadherence were identified on univariate analysis. However, logistic regression analysis singled out only the economic status. This study had updated the issue of nonadherence in renal transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.

Human Immunodeficiency Virus-related Understanding among Dental Students and Faculty of an Urban Indian Dental School

Human Immunodeficiency Virus-related Understanding among Dental Students and Faculty of an Urban Indian Dental School

A Qualitative Assessment of Breast Cancer Awareness in an Urban Indian City

Objective: To assess the awareness of breast cancer and associated risk factors among educated women from an urban population in Mumbai, India. Materials and Methods: A self-directed questionnaire-based survey was used. The questions were based on, life style habits, medical history, menstrual and contraceptive history, risk factor awareness and screening for breast cancer. Results: Nine hundred and fifty women were invited for the survey, 763 responded. The mean age of the cohort was 31 years (range 18 – 60). Knowledge about screening and breast self-examination (BSE) was evident in 682 (89.38%) of respondents. Furthermore, 334 (44%) of respondents were previously informed about BSE), of which 148 (19%) regularly performed a BSE. Awareness of breast cancer screening with mammography was reported by 310 (41%) subjects. Forty-two women (6%) had undergone mammography screening, with increased incidence among homemakers compared to professionals and students. Conclusion: The current study highlights the need for outreach programs to educate women about breast cancer and inform them about prognosis and self-evaluation methods for diagnosing the disease. In addition strategies to improve the compliance of breast screening programs are needed.

Substance Use Prevention for Urban American Indian Youth: A Efficacy Trial of the Culturally Adapted Living in 2 Worlds Program.

This article describes a small efficacy trial of the Living in 2 Worlds (L2W) substance use prevention curriculum, a culturally adapted version of keepin' it REAL (kiR) redesigned for urban American Indian (AI) middle school students. Focused on strengthening resiliency and AI cultural engagement, L2W teaches drug resistance skills, decision making, and culturally grounded prevention messages. Using cluster random assignment, the research team randomized three urban middle schools with enrichment classes for AI students. AI teachers of these classes delivered the L2W curriculum in two schools; the remaining school implemented kiR, unadapted, and became the comparison group. AI students (N=107) completed a pretest questionnaire before they received the manualized curriculum lessons, and a posttest (85% completion) 1 month after the final lesson. We assessed the adapted L2W intervention, compared to kiR, with paired t tests, baseline adjusted general linear models, and effect size estimates (Cohen's d). Differences between the L2W and kiR groups reached statistically significant thresholds for four outcomes. Youth receiving L2W, compared to kiR, reported less growth in cigarette use from pretest to posttest, less frequent use of the Leave drug resistance strategy, and less loss of connections to AI spirituality and cultural traditions. For other substance use behaviors and antecedents, the direction of the non-significant effects in small sample tests was toward more positive outcomes in L2W and small to medium effect sizes. Results suggest that evidence-based substance use prevention programs that are culturally adapted for urban AI adolescents, like L2W, can be a foundation for prevention approaches to help delay initiation and slow increases in substance use. In addition to study limitations, we discuss implementation challenges in delivering school-based interventions for urban AI populations.

Being Authentically American Indian: Symbolic Identity Construction and Social Structure among Urban New Indians

This study investigates the individual and group level reconstruction of a racial-ethnic identity. Specifically, we investigate the experience of “new Indians,” or people who did not previously identify as American Indian, but are now reclaiming this racial-ethnic heritage. Because many new Indians lack both official (tribal and/or federal) recognition of their Indian status and the phenotypic traits associated with Indians in popular culture, their authenticity as American Indians is often questioned in interactions with others. We document how new Indians work to reconstruct the symbolic meaning of authentic Indianness by emphasizing specific values and actions rather than biological lineage. Moreover, we demonstrate how new Indians achieve interactional validation of their redefined Indian identities in the context of a proximate social structure.