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You Are Here: AHRQ Home > Specific Populations > Minority Health > AHRQ Research and Other Activities Relevant to American Indians and Alaska Natives (continued)

Preventive Care

The main health challenges currently faced by American Indian and Alaska Native (AI/AN) people are the health conditions and chronic diseases related to lifestyle issues such as obesity, physical inactivity, poor diet, substance abuse, and injuries. Preventive health initiatives for AI/AN populations have been undertaken to create healthier communities, improve quality of life, decrease health care utilization, control disability, and improve productivity. Initiatives include developing, coordinating, implementing, and disseminating effective health promotion and chronic disease prevention programs through collaboration with key stakeholders and by building on individual, family, and community strengths and assets.

  • Lumbee Indians receive preventive care regardless of payer

    Lumbee Indians in North Carolina are not federally recognized and are not eligible for health care from the Indian Health Service (IHS). Consequently, they obtain their health care at a single federally funded community health center or, for those who have the means, from private physicians. Researchers surveyed 939 Lumbee Indians about their usual source of care and health status. Of these, 80 percent had a private physician, 18 percent had a public health clinician as their usual source of care, and 2 percent reported having neither. The authors found that Lumbee Indians who obtain care from a public clinic physician receive similar preventive services and have comparable health (except for more frequent use of smokeless tobacco) to Lumbee Indians whose source of care is a private physician. The finding of no differences in receipt of preventive services is notable, particularly because procedures such as prostate examinations and Pap smears require considerable time, the reasons cited most often for not following care guidelines.

    Source: Bryant A Jr, Goins RT, Bell R, et al. Health differences among Lumbee Indians using public and private sources of care. J Rural Health 2004 Summer;20(3):231-6. (Grant HS10854)

  • Program to increase clinical preventive services in Alaska

    Following technical assistance training in 2003, the Alaska Department of Health and Social Services implemented AHRQ's Put Prevention Into Practice (PPIP) program at a pilot site at Iliuliuk Clinic in Unalaska. The purpose of PPIP is to increase the appropriate use of clinical preventive services, such as screening tests, immunizations, and counseling, based on U.S. Preventive Services Task Force recommendations. Eleven of Alaska's community health center sites that receive funding as federally qualified health centers are operated by tribal health organizations. All Alaska centers serve members of the AI/AN community. Five sites have expressed interest in potential participation in the Alaska PPIP project.

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Quality of Care

A primary interest of AHRQ is improving the quality of health care in the United States. The Agency has funded several studies aimed at improving care quality for AI/ANs.

  • Collaboration creates community health information exchange network

    This project includes a collaborative partnership among 12 agencies, including a rural acute care hospital, a large American Indian tribal entity, an IHS hospital, a community health center, a health department, and a community consortium. The total patient population is 250,000 in 14 counties in rural northeastern Oklahoma. The project includes three components for improving quality of care. The first, Healthfinder, is an electronic and telephone resource to assist consumers in locating health providers and social services. It also assists providers in meeting community needs. Healthfinder (www.okhealthfinder.com) includes a special section to assist Native Americans in finding tribal and Indian Health Service resources. The second component implements an integrated community health information exchange network to facilitate provider coordination and transfer of critical patient information. The network is using Hastings Indian Medical Center, an IHS facility, and the Cherokee tribe, the second largest tribe in the country, as initial connections with the goal of allowing all IHS and Native American tribes to connect quickly and inexpensively through the network.The last component explores areas for the most cost-effective prevention strategies and adopts common objectives for prevention interventions and outcome measurement. This project builds on an earlier 1-year planning grant (HS15364) by the same investigator. (Principal Investigator: Mark Jones, Tahlequah City Hospital; Grant HS16131, 9/30/05-9/29/08)

  • AHRQ's Care Management Learning Network to improve quality

    The AHRQ's Care Management Learning Network is working with the Arizona Health Care Cost Containment System, Arizona's Medicaid agency, to implement quality improvement and performance strategies in their care management programs. In turn, Arizona's Medicaid agency is working closely with the IHS to implement a chronic care initiative unveiled in January 2007. This program will improve the care provided to low-income Native Americans living in rural areas through patient-centric and culturally sensitive methods that emphasize primary care.

  • Study seeks strategies to improve performance based on priority issues

    In addition to supporting the development of a sustainable research infrastructure for the Montana/Wyoming Tribal Leaders Council, Black Hill State University, and the Black Hills Center for American Indian Health, this project funded a study aimed at designing, implementing, and evaluating the effectiveness of a structured process in which tribal members and IHS providers jointly developed strategies to improve performance based on priority issues identified through a consumer survey. Investigators developed a targeted research agenda that addressed tribally identified priority issues, such as hepatitis C, West Nile virus, and meth-amphetamine use. (Principal Investigator: Gordon Belcourt, Montana/Wyoming Tribal Leaders Council; Grant HS14034, 9/30/03-9/29/06)

  • Quality care and error reduction in rural hospitals examined

    This project examined organizational factors influencing the rural health care provider; the delivery of patient care in rural settings; and the identification, discussion, and disclosure of medical errors and adverse events. The investigators used a Web-based intervention in the form of a curriculum accessible to health care providers in rural hospitals and designed to raise awareness, encourage error reporting, and build skills to address adverse events across 30 hospital settings in a nine-State area of the rural West. The grant also included a supplement to add minority investigators and include key contacts from 26 American Indian reservations in Idaho, Montana, North and South Dakota, and Wyoming. (Principal Investigator: Ann Cook, University of Montana; Grant HS11930, 9/30/01-9/29/04)

  • Database developed to assist in health care planning

    This grant enabled the development of a shared resource database for tribes to use in health care program planning and application development. It includes area- and tribal-specific data, “best practices” papers, and links to resources on health topics of interest to the tribes. It is currently being maintained by the Rocky Mountain Tribal Epi-Center. (Grant HS14034)

  • Survey reviews Indian Health Service optometry services

    AHRQ is providing consultation and technical assistance to IHS in developing a survey instrument that gathers data on optometric services delivery by IHS providers. AHRQ staff helped design the survey and refine the questionnaire in cooperation with the IHS survey committee. AHRQ will collect and compile the data from an estimated 100 health care sites and provide the results to IHS for analysis.

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Research Considerations

When researchers study AI/AN people, they need to be able to understand, appreciate, and use culturally appropriate strategies. By demonstrating cultural competence, researchers can avoid stereotypes and biases that can undermine their efforts. It also promotes a focus on the positive characteristics of a particular group. Cultural competence acknowledges and incorporates at all levels the importance of culture, the assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs.

  • Individual consent in research can clash with community values

    Reflecting on a decade of research among American Indians in the Southwest, the author studied the biomedical ethics of individual autonomy, which can be incompatible with the culture mores of strong family, community, and group decisionmaking. The author suggests that alternative approaches to consent and to ethics are called for.

    Source: Smith-Morris, CM. Autonomous individuals or self-determined communities: The changing ethics of research in Indian country. Human Organization 2007 Fall;66(3);327-336. (Grant HS10802)

  • AI/ANs difficult to reach by mail for research or health care

    The researchers sent a calendar with preventive health information for one group and no health information for the control group via first class mail to 5,633 patients who had been seen at a clinic during the past 2 years. Based on initial mailings and in-person location efforts, an estimated 61 percent of patients received the calendars. The mail verification process was significantly less likely to identify addresses for patients who were AI/AN and those who were seen more than 3 months before the study. In fact, AI/ANs were about half as likely as non-AI/ANs to have accurate addresses. The results suggest that it is difficult, but possible, to use the U.S. Postal Service to reach patients seen at an urban Indian health facility.

    Source: Duffy D, Goldberg J, Buchwald D. Using mail to reach patients seen at an urban health care facility. J Health Care Poor Underserved 2006 Aug;17: 522-31. (Grant HS10854)

  • Nearly half of urban AI/ANs travel back to their reservation yearly

    Of the more than two million AI/ANs living in the United States today, only 25 percent reside on reservations, while 60 percent live in cities. Those who live in cities often travel to reservations, yet little is known how this travel may be related to health. Researchers surveyed more than 500 AI/AN adults at a primary care clinic in Seattle about time spent visiting a reservation during the past year, and the person's sociodemographic, cultural, and clinical characteristics. Thirty-four percent of respondents had spent up to 30 days traveling, 14 percent had spent more than 30 days traveling, and 52 percent had not traveled to reservations. Strong Native American cultural identification, presence of lung disease, absence of thyroid or mental problems, and greater dissatisfaction with care were independently associated with more travel to reservations. Reservation visits were not consistently linked to self-reported health outcomes, nor could the researchers determine how often respondents traveled to the reservation for health care. The findings underscore the importance of considering the role of culture as well as residence and patterns of travel in both research and clinical care involving AI/ANs.

    Source: Rhoades DA, Manson SM, Noonan C, Buchwald D. Characteristics associated with reservation travel among urban Native American outpatients. J Health Care Poor Underserved 2005 Aug;16(3):464-74. (Grant HS10854)

  • Strictly translated informed consent documents promote mistrust

    Interpreters and a Navajo language consultant developed a translation in Navajo of a standard consent form for participating in a study. After using the form for 4 months, the researchers learned that the formal consent process often led to confusion and mistrust of the research. The researchers stress that cross-cultural communications and translations increase effectiveness.

    Source: McCabe M, Morgan F, Curley H, et al. The informed consent process in a cross-cultural setting: Is the process achieving the intended result? Ethn Dis 2005 Spring;15(2):300-4. (Grant HS10637)

  • Local review by American Indians can affect health research endeavors

    The authors used case examples of health studies involving older American Indians (age 50 or older) among Eastern Band Cherokee Indians, the Cherokee Nation, and Lakota tribal members living in Rapid City, South Dakota. They found that local decisionmaking reflects the legal and historical factors that underpin American Indian sovereignty. While specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders.

    Source: Manson SM, Garroutte E, Goins RT, et al. Access, relevance, and control in the research process: Lessons from Indian country. J Aging Health 2004 Nov;16(5 Suppl):58S-77S. (Grant HS10854)

  • Language nuances key in communication

    While developing a pamphlet on diabetes for Navajo Indians, researchers found they had to pay attention to cultural factors, regional language differences, and the possibility of a lack of word-for-word translation. A translation of an outwardly simple diabetes questionnaire from English into Navajo let the translators articulate approaches that can be used in explaining diabetes management in an appropriate cultural context.

    Source: McCabe M, Morgan F, Smith M, et al. Lessons learned: Challenges in interpreting diabetes concepts in the Navajo language. Diabetes Care 2003 June;26(6):1913-14. (Grant HS10637)

  • Project explores data privacy and bioethical views

    This qualitative study examined the effects of ethnicity and rurality on patient and consumer perspectives about health data privacy and confidentiality using 18 focus groups composed of members of American Indian (Navajo, Pueblo) and Latino (both native and immigrant) communities. The study found that while some community members maintain an accepting view of current research processes, others express distrust in research, researchers, and processes for protection of data privacy. These negative views are based on previous community experience with research endeavors and their apparent lack of benefits to the communities. The study suggests that researchers need to create active partnerships with communities, ensure feedback and benefits to these communities, and devote attention to privacy protections. (Principal Investigator: Robert Williams, University of New Mexico; Grant HS13208, 7/1/02- 12/30/03)

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Research Infrastructure Development

A major AHRQ goal is to build research infrastructure and enhance opportunities for AI/AN investigators in health services research. For example:

  • In addition to building the research capacity for the Native American Research Center for Health (NARCH), this multiyear project aims to identify which health care characteristics of tribal health program service systems are associated with preventable hospitalizations. AHRQ became a partner in the NARCH program in 2005, supporting the California Rural Indian Health Board's NARCH grant.. This program—which aims to develop opportunities for conducting research and research training that respond to the needs of AI/AN communities—is predominantly funded by the National Institutes of Health and managed by the IHS. The centers are working partnerships between AI/AN organizations and research-intensive institutions. Further information on the NARCH grants can be found at http://www.ihs.gov/MedicalPrograms/Research/narch.cfm.
  • AHRQ is an active supporter of the Tribal College and University Initiative of the Department of Health and Human Services. AHRQ has employed Tribal College and University and other American Indian students for summer internships since 1999, as well as during additional academic terms in 2001, 2002, and 2006. AHRQ will continue to foster interest in the health services research field among tribal college students through its summer internship program.
  • In response to a stated need on the part of the American Indian Higher Education Consortium, an umbrella organization for tribal colleges, AHRQ offered statistical support for a research study by the group on public health issues and tribal colleges. Also, in November 2003, Dr. Carolyn Clancy, AHRQ Director, sent a letter to all tribal college presidents reintroducing them to the Agency and its work (previous letters had been sent in 2000 and 1998) and encouraging them to contact AHRQ to discuss possibilities for joint efforts.

AHRQ contributed to the 2002 meeting of the National Alaska Native American Indian Nurses Association. In addition to financial support, AHRQ staff conducted a session on funding opportunities, the grants process, and review procedures for nurse researchers.

  • Project focuses on healthy weight and cancer outcomes for women

    This continuation grant builds upon its earlier capacity-building success during which the Montana-Wyoming Tribal Leaders Council developed a shared data resource and research infrastructure for participatory research among a majority of the 10 tribes it serves. The continuation project will further build capacity for health care research on the priority health issues identified by the tribes and continue to support culturally appropriate health programs. Three new research studies are planned: evaluation of interventions to promote healthy weight among women, examination of factors that contribute to breast and cervical cancer outcomes, and design and implementation of a “healthy reservations” model program for system-wide health improvement on reservations. (Principal Investigator: Gordon Belcourt, Montana-Wyoming Tribal Leaders Council; Grant HS14034, 9/30/06-9/29/11)

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Technology (Health Information Technology, Telehealth)

Health care is information intensive and increasingly dependent on technology to ensure that appropriate information is available whenever and wherever it is needed. AHRQ is assisting the IHS in enhancing its health information systems to improve quality of care and patient safety. For example, AHRQ:

  • Supported a collaborative, multimillion-dollar effort by the IHS to develop and deploy an electronic health record and population health management system and to investigate the effect of the system on the quality and safety of health care delivery in IHS facilities. The Resource Patient Management System's Electronic Health Record permits direct provider order entry and documentation, thus increasing data quality and patient safety. It also includes elements of electronic decision support. The result of this work was the deployment of an electronic health record to more than 120 sites. Products the IHS developed are in the public domain and have been adopted by Federal and State agencies and community-based organizations.
  • Is maximizing functionality of the Resource Patient Management System software component, the Population Management graphical user interface, called iCARE. This software application is designed to integrate multiple perspectives on clinical and community care in a single software application.
  • Provided partial funding and technical assistance for an evaluation of the deployment and impact of the Resource Patient Management System's Electronic Health Record. AHRQ assisted the evaluation team at the Urban Indian Health Institute (part of the Seattle Area Epidemiology Center) and Harvard University with evaluation methodology, design, and analysis.
  • Assisted the IHS in improving outcomes in chronic illness care and preventive services through:
    • Contributing to the building of an infrastructure for quality improvement and collaborative learning.
    • Adapting and implementing the Chronic Care Model in Federal, tribal, and urban facilities.
  • California implements information technology systems for rural Indian clinic health care

    The California Rural Indian Health Board in September 2004 began partnering with three of its rural tribal health programs that implemented electronic health records with clinical decision support systems in an effort to reduce hospitalizations that may be preventable through improved care quality and reduced medical errors. The information technology systems that result will be used in conjunction with local hospitals to support the review of all hospitalizations for their preventability and to track the programs' medical and medication errors as well as their clinical care performance according to standardized performance guidelines. (Principal Investigator: Linda Aranaydo, California Rural Indian Health Board; Grant HS15339, 9/20/04-8/31/07)

  • Telehealth initiative sparks health information campaigns

    The authors examined the Native TeleHealth Outreach and Technical Assistance Program that transfers knowledge of health telecommunication technologies to community health professionals to empower them to use these resources in their communities. The program offered instruction on telehealth for care providers, who in turn developed culturally relevant information for recipients on health topics via CDs, videos, Web sites, and brochures.

    Source: Dick RW, Manson SM, Hansen AL, et al. The native telehealth outreach and technical assistance program: A community-based approach to the development of multimedia-focused health care information. American Indian and Alaska Native Mental Health Research: J National Center 2007;14(2):49-66. (Grant HS10854)

  • Health collaborative technology assessed in Alaska's Central Kenai Peninsula

    This project assessed the status of technological resources of a federally qualified health center for uninsured and underinsured patients, a mental health clinic, a long-term care provider, and a local acute care hospital serving a population of Alaska Natives, disabled, and poor patients. The study team prepared a plan for implementing health information technologies to allow for area-wide electronic communications and connectivity with an electronic health record and a Web-based data system for patient support. (Principal Investigator: Susan Caswell, Central Peninsula General Hospital; Grant HS14902, 09/30/04-09/29/06)

  • Patients and clinicians receptive to telepsychiatry services for youth

    To address the shortage of practitioners in child and adolescent psychiatry, the use of real-time interactive videoteleconferencing to deliver psychiatric services, or telepsychiatry, has been proposed as a way to meet the needs of American Indian youth. The authors reviewed the progress of a twice-monthly telepsychiatry program for children and adolescents undertaken by the University of Colorado School of Medicine's Center for Native American TeleHealth and TeleEducation and the IHS's Rapid City Hospital. Parents said they preferred the service to the 350-mile drive they would otherwise need to make to get help for their children, and clinicians said teleconsultations helped in diagnosing and managing complicated patients and families.

    Source: Savin D, Garry M, Zuccaro P, et al. Telepsychiatry for treating rural American Indian youth. J Am Acad Child Adolesc Psychiatry 2006 April 45(4):484-8. (Grant HS10854)

  • Data collection systems enhanced in primary care Practice-Based Research Networks

    Two AHRQ-supported PBRN projects were designed to develop electronic data system capacity in networks serving large numbers of AI/AN patients:

    • The Oklahoma Physicians Resource/Research Network increased training in and utilization of personal digital assistants to ensure that all member practices were able to collect and transmit research data electronically and better utilize the personal digital assistant's Web-based Preventive Services Reminder System to collect routine practice data and increase the delivery and documentation of preventive services. At the conclusion of the study period, 13 practices and 20 clinicians were using the reminder system to report on service delivery and patient sociodemographic information. Four Native American clinics participated in network projects. (Principal Investigator: James Mold, University of Oklahoma; Grant HS13557, 9/30/02-9/29/05)
    • The Research Involving Outpatient Settings Network, or RIOS Net, is composed of clinicians in IHS facilities, community health centers, and university-supported practices which serve culturally diverse, medically underserved, and low-income communities in New Mexico. Among the objectives of this completed study was a pilot project to learn more about the process of primary prevention and risk factor reduction. Data were gathered through various methods to explore provider decisionmaking on obesity counseling during the patient encounter. Investigators found the decision on whether to counsel was influenced less by clinical guidelines than by patient factors and external considerations. (Principal Investigator: Robert Williams, University of New Mexico; Grant HS11229, 9/30/00-9/29/02)
  • Telepsychiatry clinics offer a model to increase care to rural American Indian communities

    The authors describe the rural telepsychiatry clinics run by the American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center through a partnership with the Department of Veterans Affairs, the IHS, and local tribal health services. This service may offer a means to increase access to care for rural American Indian communities. The clinics primarily offer assistance to American Indian veterans with PTSD. Describing the model used for developing the services, the authors trace the program development, discuss challenges in implementing services, and offer solutions. The model can guide the development of telepsychiatry services for American Indians, especially rural populations.

    Source: Shore JH, Manson SM. A developmental model for rural telepsychiatry. Psychiatr Serv 2005 Aug;56(8):976-80. (Grant HS10854)

  • Information technology key to improving safety

    The authors reviewed findings from nine studies conducted in rural communities in a 14-State area and data from an ongoing patient safety research effort. Those findings suggest that information technology is an integral part of a system-wide approach to safety. Staffing, communication, and availability of resources and training are also part of the approach.

    Source: Cook AF, Hoas H, Guttmannova K. Not by technology alone. Project seeks to assess and aid patient safety in rural areas. Biomed Instrum Technol 2003 Mar-Apr;37(2):128-30. (Grant HS11930)

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Tobacco Use

Traditional tobacco has a spiritual role in Indian culture and varies from tribe to tribe. By some estimates, American Indians have used the tobacco plant for more than 18,000 years. Traditional tobacco is still used by many tribes for prayer, ceremonies, offerings, gift-giving, or as a healing medicine. Commercial tobacco use, however, is also significant among AI/ANs. Nearly 41 percent of AI/ANs are smokers. This is the highest rate of tobacco use among every age, ethnic, and gender category in the United States. Between 1983 and 2002, adult smoking rates fell in all racial and ethnic groups except for American Indians and Alaska Natives.

  • Northern Plains American Indians smoke more than Southwest Plains Indians

    This cross-sectional study of Southwest and Northern Plains American Indians (ages 15 to 54) found that about half of Northern Plains men and women currently smoked (49 and 51 percent, respectively), while 19 percent of Southwest men and 10 percent of Southwest women smoked. The study did not determine use of tobacco for ceremonial purposes. However, the Northern Plains tribe bases a large part of their spiritual philosophy around the concept of the “sacred pipe,” considerably more so than the Southwest tribe. Thus, the differences in smoking rates could have a cultural basis. Men and younger people were more likely to smoke in the Southwest tribe but not the Northern Plains tribe. This finding is consistent with other studies that suggest cigarette smoking among tribes of the Southwest region is on the rise, especially among younger men. The results underscore the need to consider each tribal group's unique characteristics when designing and implementing culturally sensitive smoking intervention programs in American Indian communities.

    Source: Nez Henderson P, Jacobsen C, Beals J. Correlates of cigarette smoking among selected Southwest and Northern plains tribal groups: The AI-SUPERPFP Study. Am J Public Health 2005 May;95(5):867-72. (Grant HS10854)

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Traditional Medicine

Many AI/ANs use traditional practices to address their health care concerns.

  • Traditional herbs do not affect diabetes medication

    Many Native Americans integrate traditional herbs with Western medicine, though there is limited data on the herbs' efficacy. During a randomized clinical trial from 2001-2003 on the Navajo Nation, 30 percent of the participants said they used herbs as medicine. Of the participants with diabetes who used traditional herbs, the study found no measurable adverse interaction with diabetes control.

    Source: McCabe M, Gohdes D, Morgan F, et al. Herbal therapies and diabetes among Navajo Indians. Diabetes Care 2005 Jun;28(6):1534-5. (Grant HS10637)

  • Agency supports conferences on government coverage of traditional indigenous medicine

    AHRQ has supported conference discussions on traditional indigenous medicine in three settings over a 5-year period. The first discussion formed part of a larger international ethics conference in London in 2000; the second, held in Arizona in 2001, specifically focused on the importance of traditional practices to Native American communities. Attendees at the 2001 meeting addressed issues surrounding the need for support of traditional practitioners and the role of indigenous medicine, both in Tribes' economic self-sufficiency and in government-supported health systems. The final project report is available from the National Technical Information Service and can be ordered by referencing NTIS Accession No. PB2005-102221. The most recent conference, held in August 2005, was planned and coordinated by the National Center for Complementary and Alternative Medicine at the National Institutes of Health with additional support from AHRQ and the IHS. The meeting focused on research in traditional indigenous medicine. (Principal Investigator: J. Kristin Olson-Garewa, University of Arizona; Grant HS10930, 8/15/00-2/14/2002)

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Trauma

Injury is a leading cause of death and disability for AI/AN communities. Overall, unintentional injury is the third leading cause of death among AI/ANs, and suicide and homicide are among the top 10 causes of death. Injuries and violence are especially a burden for the young AI/AN population, accounting for 75 percent of all deaths among those ages 1 to 19. Unintentional injury, suicide, and homicide are respectively the top three killers among AI/ANs 1 to 44 years old, accounting for 54 percent of all deaths. Injuries cause more deaths among AI/ANs 1 to 44 years of age than all other causes combined. Unintentional injuries account for more years of potential life lost among AI/AN than heart disease, cancer, and diabetes combined.

  • Trauma linked to alcohol problems in American Indians

    American Indians experience more traumas and alcohol disorders than the general population. Researchers interviewed 432 American Indians between the ages of 15 and 24, asking participants if they had experienced any of 16 types of traumatic events and about their use of alcohol. Overall, 21 percent had experienced one severe traumatic event, 10 percent had experienced two, and 16 percent had experienced three or more. Young adults (aged 20-24) experienced more traumatic events than adolescents (aged 15-19), as did participants in both age groups who reported that their parents used alcohol while they were growing up. More than one-fourth (26 percent) of those interviewed were diagnosed with alcohol use disorders. The odds for alcohol use disorders increased from nearly twofold for one trauma to somewhat less than fourfold for three or more traumas compared with no trauma. These results held after adjusting for age, gender, and parental alcohol use, suggesting a dose-response effect of trauma on alcohol disorders among American Indians living on or near reservations.

    Source: Boyd-Ball AJ, Manson SM, Noonan C, et al. Traumatic events and alcohol use disorders among American Indian adolescents and young adults. J Traumatic Stress 2006 Dec;19(6):937-47. (Grant HS10854)

  • Trauma strikes American Indians more often than the general U.S. population

    Southwest and Northern Plains American Indians more often witness a traumatic event, suffer trauma to loved ones, and are the victims of physical attacks than the general U.S. population, according to this study of trauma exposure among two tribes. Researchers interviewed 3,084 members of two tribes about their exposure to 16 types of trauma. They compared tribal prevalence rates of trauma with a sample of the U.S. general population in the National Comorbidity Survey. Lifetime experience of any trauma was high across both tribes, ranging from 62.4 percent for male Southwest tribe members to 69.8 percent for female Northern Plains tribe members. This compares to lifetime exposure to any trauma among U.S. men and women at 60.7 percent and 51.2 percent, respectively. The researchers suggest that high rates of trauma exposure may contribute to the increasing prevalence of CVD, the leading cause of death among American Indian men and women. Similarly, trauma is closely linked to pain, which negatively affects compliance with treatment, help-seeking, and the speed of surgical recovery, all of which are often compromised in American Indians.

    Source: Manson SM, Beals J, Klein SA, et al. Social epidemiology of trauma among 2 American Indian reservation populations. Am J Public Health 2005 May;95(5):851-9. (Grant HS10854)

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Women's Health

AI/AN women have striking health concerns. They give birth to children at younger ages than do women in the general U.S. population. High birthweight births of 4,000 grams or more (versus low birthweight births) are a relatively greater problem for AI/AN women. These women generally begin prenatal care later than other women in the United States and are more likely to exhibit risky behaviors, such as smoking or consuming alcohol, during pregnancy than their counterparts in the United States.

  • Study looks at breast and cervical cancer screening and followup

    In addition to supporting the development of a sustainable research infrastructure for the Montana/Wyoming Tribal Leaders Council, Black Hill State University, and the Black Hills Center for American Indian Health, this project funded a study for identifying factors that affect breast and cervical cancer screening and followup of abnormal findings. Investigators developed a pilot program to increase the proportion of American Indian women who receive screening tests. (Principal Investigator: Gordon Belcourt, Montana/Wyoming Tribal Leaders Council; Grant HS14034, 9/30/03-9/29/06)

  • Extremely obese American Indian and Alaska Native women may have higher bone mineral density compared to extremely obese non-Hispanic white women

    Researchers compared baseline bone mineral density (BMD) of 139 AI/AN postmenopausal women with 1,431 non-Hispanic white postmenopausal women to determine the variability of BMD, osteoporosis, and hip fractures. The AI/AN women studied were twice as likely to be obese (body mass index of 30-39.9) or extremely obese (BMI of greater than 40) than non-Hispanic white women. The extremely obese AI/AN women had higher hip BMD than non-Hispanic white women, but overweight AI/AN women had slightly lower spine and whole body BMD compared to non-Hispanic white postmenopausal women.

    Source: Wampler NS, Chen Z, Jacobsen C, et al. Bone mineral density of American Indian and Alaska Native women compared with non-Hispanic white women: Results from the Women's Health Initiative Study. Menopause: J North Am Menopause Society; 2005 Sep-Oct;12(5): 536-44. (Grant HS10854)

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Glossary

Abreviation Full Name
AHRQ Agency for Healthcare Research and Quality
AI/AN American Indian/Alaska Native
BMD bone mineral density
CVD cardiovascular disease
HDL-C high density lipoprotein cholesterol
HHS Department of Health and Human Services
IHS Indian Health Service
NARCH Native American Research Centers for Health
PPIP Put Prevention Into Practice
PTSD post-traumatic stress disorder

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For More Information

For further details about AI/AN projects and other activities at AHRQ, contact:

Wendy Perry
AHRQ Senior Program Analyst for AI/AN Health
540 Gaither Road
Rockville, MD 20850
E-mail: Wendy.Perry@ahrq.hhs.gov

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Current as of January 2008
AHRQ Publication No. 08-P004
Replaces AHRQ Pub. No. 06-P021

Internet Citation:

AHRQ Research and Other Activities Relevant to American Indians and Alaska Natives. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 08-P004, January 2008. http://www.ahrq.gov/research/amindbrf.htm

 
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