Urban Indians Research Articles

Evaluating bias with loss to follow-up in a community-based cohort: empirical investigation from the CARRS Study

BackgroundRetention of participants is a challenge in community-based longitudinal cohort studies. We aim to evaluate the factors associated with loss to follow-up and estimate attrition bias.MethodsData are from an ongoing...

Fusion Street Food Trend in Urban Indian Cities Surpassing the Conventional Taste Modalities: Discussion and Word Cloud Analysis

Fusion Street Food Trend in Urban Indian Cities Surpassing the Conventional Taste Modalities: Discussion and Word Cloud Analysis

Did You See Us? Reunion, Remembrance, and Reclamation at an Urban Indian Residential School

Did You See Us? Reunion, Remembrance, and Reclamation at an Urban Indian Residential School

Developing a Menopausal Transition Health Promotion Intervention With Indigenous, Integrative, and Biomedical Health Education: A Community-Based Approach With Urban American Indian/Alaska Native Women.

Few studies have examined the menopausal transition in American Indian and Alaska Native (AI/AN) women; these reports indicate they are the most likely group to report bothersome vasomotor symptoms (VMS). Evidence demonstrates VMS may be a biomarker for chronic diseases. Thus, evidence-based interventions to improve VMS and other symptoms and health-screening rates for urban midlife AI/AN women are needed. The objectives of this community-based project were to form a Community Advisory Board (CAB) with whom to: 1) conduct CAB meetings (similar to a focus group) with midlife AI/AN women to understand their lived health care experiences and needs during the menopausal transition; and 2) obtain guidance in creating a tailored intervention. Eligible participants indicated they were registered members of American Indian Tribes, self-identified as a woman, aged 35 or older, and were recruited through the Urban Indian Center of Salt Lake and community outreach. Three CAB meetings were conducted via Zoom. A qualitative-descriptive approach was used for analysis, with the aim of staying close to the data to understand AI/AN women's experiences and needs. Transcripts were iteratively coded using content/thematic analysis. Four themes emerged: 1) lack of and desire for information about the menopause transition; 2) barriers to accessing care; 3) matriarchal priorities impacting personal health outcomes; and 4) preferences for Indigenous and integrative medicine as first-line interventions, followed by conventional medicine. Among this sample of urban AI/AN women, there was a great need for and interest in information about menopause, both for themselves and for their daughters and family. Integrative and Indigenous approaches were preferred. Proposed next steps include developing and pilot-testing a nurse-delivered health-education intervention with Indigenous, integrative, and conventional medical content.

A Comparison of the Prevalence of Diabetes between Aging Rural and Urban Indians.

AbstractBackgroundDiabetes is one of the important modifiable risk factors for dementia. Its prevalence has been increasing rapidly in the past few decades across the world, particularly in India. However, among Indians, there are prominent lifestyle differences between rural and urban residents. Hence, understanding diabetes prevalence in these two distinct populations is essential to understand the differential risk for dementia in rural and urban Indians.MethodCross‐sectional (baseline) clinical data from two ongoing prospective cohort studies, namely Srinivaspura Aging, Neuro Senescence and Cognition (SANSCOG) study in rural India and Tata Longitudinal Study of Aging (TLSA) in urban India was utilized for the present study. A total of 6002 participants – 4913 rural (SANSCOG) and 1089 urban (TLSA) were included. Diagnosis of diabetes was made using self‐reported history and / or fasting blood glucose level of > 126 mg/dl. Chi‐square test of independence was used to assess the group differences between the rural and urban participants – both overall and gender‐wise and age group‐wise.ResultThe mean age of participants was 63.93 ± 9.56 years and 58.74 ± 9.88 years for the urban and rural cohorts, respectively. Prevalence of diabetes was significantly higher in urban than rural subjects – overall (33.6% vs. 19.3%, p<0.001) as well as among males (38.4% vs. 24.1%, p<0.001) and females (28.7% vs. 14.8%, p<0.001). Similarly, on age stratification, urban subjects had significantly higher prevalence than rural subjects in the age groups <65 years (28.1% vs. 18.3%, p<0.001) and ≥65 years (39.5%vs. 21.3%, p<0.001).ConclusionUrban subjects had significantly higher diabetes prevalence than rural subjects across both genders and age groups. In view of the association of diabetes with dementia risk, these findings could imply that urban Indians may be at higher risk for pathological cognitive impairment and dementia as compared to their rural counterparts. However, longitudinal follow of these participants with cognitive monitoring is required to establish a causal association.

To evaluate the adequacy of dietary intake of protein and immune nutrients in urban indians aged 40-60 years as per recommended dietary allowances (RDA) and estimated average requirements (EAR) 2020 guidelines

To evaluate the adequacy of dietary intake of protein and immune nutrients in urban indians aged 40-60 years as per recommended dietary allowances (RDA) and estimated average requirements (EAR) 2020 guidelines

OMEGA-3 – ONLY VIRTUALLY BENEFICIAL FOR THE VEGANS & FANATIC VEGETARIANS!

Dear Reader, Dinner table conversations revolve around food, travel, politics and now, increasingly, health and nutrition – post the COVID-19 surge. Amongst the conditions commonly discussed, products for immunity, diabetes and heart disease take precedence. Besides immune builders, omega-3 (also referred to as n-3) has become the ‘talk of the town’ since it can benefit both the heart and also diabetes from which nearly 10% of urban Indians suffer.

Behavioral health services for urban American Indians and Alaska Natives: A thematic analysis of interviews with 10 program directors.

Urban Indian Health Programs (UIHPs) are one of the primary sources of government-funded health care for the millions of American Indian and Alaskan Native (AI/AN) people living in urban areas. The goal of this study is to better understand what services are available at UIHPs and how resources are being used to support these services. Semistructured interviews with behavioral health directors at 10 UIHPs were reported, transcribed, and thematically analyzed to address this knowledge gap. Our analysis indicates that UIHP behavioral health services were broad, encompassing numerous commitments that extend far beyond purely psychotherapeutic interactions and interventions to the periphery of behavioral health. An accurate accounting of behavioral health services at UIHPs must consider not only the ways that these services are shaped by distinctive visions to provide Indigenous cultural education and traditional healing, but also by expansive commitments to offering a full range of social services, case management, and community building under the broad umbrella of behavioral health. Implications of these findings include the need for additional funding for UIHPs, greater sponsorship of pathway training programs for AI/ANs in the mental health professions to increase the availability of AI/AN providers, future expansion of traditional healing practices, and direct empirical observation of behavioral health service delivery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program

According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization’s response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures “knowledge,” “ask directly,” “respond,” “comfort,” and “preparedness.” Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.

The Portrayal of American Indian Identity in The Lone Ranger and Tonto Fistfight in Heaven

This study delved into the cultural identity of American Indians residing in the Spokane reservation area, with a focus on Sherman Alexie's collection of stories, "The Lone Ranger and Tonto Fistfight in Heaven." The stories portrayed various aspects of the divide between American Indians and white people, as well as the distinctions between reservation-based Indians, urban Indians, modern Indians, and traditional Indians. The main objective of the research was to explore how the identity of American Indians is depicted in Alexie's book using Homi K Bhabha's cultural identity theories of hybridity and mimicry. This study employed the literary criticism method, particularly postcolonial studies, to analyze the representation of hybridity and mimicry. The primary data source for this investigation was the collection of short stories, "The Lone Ranger and Tonto Fistfight in Heaven," by Sherman Alexie. The data was gathered from the text, identifying words or sentences that illustrate the representation of hybridity and mimicry in the stories. The data collection techniques include reading and note-taking strategies. This study revealed two main aspects of Indian cultural identity: Hybridity, characterized by a blend of Indian and white culture, evident in language, behavior, ways of thinking, and lifestyles. Then Mimicry, seen in Indian behavior, lifestyle, and ways of thinking that resemble those of white people. In conclusion, the research highlighted how Indian cultural identity in Sherman Alexie's work reflects both hybridity and mimicry, shedding light on the complexities of cultural assimilation and adaptation in American Indian communities.

Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India.

Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.

Romantic Relationships During Career Building Phase among Urban Indian Emerging Adults

This descriptive study investigates the romantic relationship experiences of emerging adults (N=510) during the career development phase. Emerging adulthood is a stage that typically occurs between the ages of eighteen and twenty-five. The most crucial developmental responsibilities during this time are establishing a career and finding a partner. Emerging adults (18 to 25 years old) enrolled in various colleges and institutions throughout Indian states were chosen at random for the study. The urban data points were the focus. Data collection was done using a structured questionnaire and a quantitative methodology. Romantic connections and the amount of time spent on educational/career advancement are two significant themes of the paper. It discusses the typical length of romantic partnerships as well as the variations in romantic relationship experiences between male and female participants. Certain statistical measures, such as frequency distribution and measures of connection between socio-demographic and different criteria variables, were utilised to describe the results. Understanding relationship forms and contemporary issues affecting youngsters is made easier by the findings.

621-P: Subphenotyping of Type 2 Diabetes Based on Pathophysiology and Its Association with Diabetes Remission in Urban Indians

Background and Aim: Sub-classification of type 2 diabetes (T2D) based on pathophysiological abnormalities is documented to facilitate better T2D management. Aim of the study was to classify 270 Indian patients with recently diagnosed T2D based on phenotype and the impact of each phenotype on the rate of remission, after a structured diabetes remission program. Methods: We retrospectively extracted and analyzed baseline data of patients with T2D (diagnosed as per WHO criteria) enrolled for a one-year diabetes management program at the Freedom from Diabetes Clinic, India. Inclusion criteria included a recent diagnosis of T2D (<2 years). Using the homeostatic assessment model, patients were categorized into 3 sub-phenotypes: insulinopenic (high insulin sensitivity (IS) and low beta cell function (BCF)), classical (low IS and low BCF), and hyperinsulinemic (low IS and high BCF) T2D. Post-intervention, remission was defined as maintaining HbA1c<48 mmol/mol without the use of glucose-lowering medications for at least 3 months. Results: Of the 270 patients, the majority were hyperinsulinemic (35.9%) followed by insulinopenic 17.4% and classical (13.3%) T2D. Additionally, a novel category of patients with both high IS and high BCF was observed (labeled ‘Unclassified’-33%). Hyperinsulinemic patients had the highest BMI (median 28 kg/m2), dyslipidemia, hypertension, and history of heart disease with the lowest remission rate (14.4%). One in four classical patients was on oral hypoglycemic agents and showed poor glycemic control but 25% remission. Unclassified patients showed the highest remission (28.1%). Conclusion: Pathophysiological sub-phenotyping could assist caregivers in better management of T2D through targeted treatment options. Remission rates were observed to be better in classical and unclassified (high insulin sensitivity and beta function) T2D. Further large-scale studies to understand the unclassified group are warranted. Disclosure P.Tripathi: Board Member; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.

Reclaiming Our Narratives: An Indigenous Evaluation Framework for Urban American Indian/Alaska Native Communities

Aligning with the Western Door—Do Good Work, this article outlines Urban Indian Health Institute’s (UIHI) Indigenous Evaluation Framework, created to explicitly include and empower urban Indigenous communities to reclaim their narratives by using evaluation as a tool to tell their stories and to build capacity to take ownership of research and evaluation. The framework includes the following core values: Urban Indigenous People Create Communities Wherever They Are, Resilient and Strength-Based, Decolonize Data, and Community Centered. The authors provide an overview of how they applied the framework in collaboration with 18 urban Indian organizations through the UIHI’s community grants program and include a first-hand example of implementation of the framework from the Native American Youth and Family Center, a community grantee. The authors highlight the importance of including urban Indigenous people in evaluation contexts, as evaluation is not just an exercise in methods or logistics but also a political act and an assertion of Indigenous values and sovereignty, one that defines who is counted, how people are counted, and what decisions are made. The UIHI’s Indigenous Evaluation Framework aims to decolonize data to reclaim urban Indigenous narratives from colonial understandings and tell the stories of our communities.

Nutrient Diversity and its Association with Type 2 Diabetes Mellitus in Urban Indian Population

Background: Nutrient diversity is one of the key factors of a balanced diet because of its correlation with macronutrients and micronutrients. Aims and Objectives: The objective of the study was to assess daily dietary intake and get urban Indian data based on the regional dietary intake of the subjects. Materials and Methods: Nutrient diversity was inferred using a food frequency questionnaire and 24-h dietary recall along with other variables such as demographic data, income, education, lifestyle, number of meals per day, and addictions. Average, mean, and standard deviation were calculated for all of these. Results: Results showed a positive correlation between nutrient diversity and its association with type 2 diabetes mellitus. The average dietary intake of the study showed that the subjects consumed a diet high in carbohydrates and fat while the protein and micronutrient intake was on the lower side. A large variation was observed in the average nutrient intake from different food groups. Conclusion: The current study concluded that the nutrient diversity amongst the subjects is an indicator to risk of diabetes and pre–diabetes.

Impact of Diet on Nutrient Intake, Glycemic Index and Glycemic Load of Meals of Urban Indian Diabetic Population

Background: India is heading toward becoming the global diabetic capital directly interconnected to poor lifestyle and obesity. Aims and Objectives: The aim of the study was to find an association between glycemic index (GI) and glycemic load (GL) with macronutrients and fiber in the diet of the urban Indian population. Materials and Methods: The dietary intake using food frequency questionnaire and 24–h dietary recall of 240 recruited subjects (male and female), between 25 and 60 years were taken in the study. GI and GL of all meals were calculated using values from National and the International Table of GI and GL. Results: Average mean and standard deviation of GI and GL of major meals were on the higher side. A significant correlation between GI of lunch and dinner with total available carbohydrate (CHO) and total starch intake. A positive significant correlation was observed between GI to energy intake at dinner, total available CHO, and total starch. GL of breakfast was negatively correlated to iron, zinc, insoluble, and soluble fiber intake in females. GL for lunch was positively correlated to the intake of total available CHO, total starch, insoluble, and soluble fiber. Conclusion: The present study showed high GI and GL of processed foods and refined CHO indicating that dietary habits with high GI and GL foods are an indicator to risk of diabetes and pre-diabetes among both genders.

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

Behavioral health services in Urban American Indian Health Programs: Results from six site visits.

This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs).Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts.These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing.Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well-being.

Cardiorespiratory fitness and body fat percentage in young adults

Relevance. Maximal oxygen consumption (VO2max) is the maximum amount of oxygen an individual can breathe in and utilize it to produce energy aerobically. The global epidemic of overweight and obesity -’globesity’ is emerging as a public health problem in many parts of the world. Almost 30-65 % of adult urban Indians is either overweight or obese or has abdominal obesity. Recently, cardiovascular ailments are increasing in the younger generation. Low levels of cardiovascular fitness and unfavorable cardiovascular risk profiles are detected in them. Total body fatness and aerobic capacity are frequently used in association with each other and it is often implied that these parameters are strongly inter-related. Both body fatness and status aerobic fitness have been shown to be risk factors for future health outcomes. The aim of this study was to assess the correlation of cardio-respiratory fitness with body fat percentage in young adults. Materials and Methods. This was a pilot study conducted in a group of 100 subjects of age group 18 to 25 years. Ethical clearance was obtained from institutional ethical committee and written informed consent were taken from all subjects participated in the study. Following parameters were taken (a) anthropometric parameters, (b) body fat percentage, (c) physical activity level and (d) VO2max. Results and Discussion. The mean ± SD for age, height, weight, global physical activity questionnaire (GPAQ score) and VO2max was found to be higher in male participants as compared to female participants while BMI was almost equal in both the genders but body fat percentage was higher in female participants. There was positive non-significant correlation of VO2max with body mass index and global physical activity in female subjects but positive significant in male subjects. And moderate negative correlation between body fat percentage and VO2max in male and female subjects but not significant (p 0.05). Conclusion. Body fat percentage was negatively correlated with maximum oxygenconsumption (VO2 max).

To evaluate the adequacy of dietary intake of protein and immune nutrients in urban indians aged 40-60 years as per recommended dietary allowances (rda) and estimated average requirements (ear) 2020 guidelines.

To evaluate the adequacy of dietary intake of protein and immune nutrients in urban indians aged 40-60 years as per recommended dietary allowances (rda) and estimated average requirements (ear) 2020 guidelines.