Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population

Authors: Garcia, A. N., Venegas-Murrillo, A., Martinez-Hollingsworth, A., Smith, L. V., Wells, K., Heilemann, M. V., Fischbach, L., Cummings, P. L., & Kuo, T.

Publication Year: 2023

Last Updated: 2023 May 18

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Keywords: Federal Health Care; Health Care Access; IHS

 

Short Abstract: Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County.

 

Abstract: Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs’ usual sources of care (e.g., IHS, community clinics).

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10195651/

Type of Resource: Peer-reviewed scientific article

The Culture is Prevention Project: Measuring Cultural Connectedness and Providing Evidence that Culture is a Social Determinant of Health for Native Americans

Authors: Paul Masotti, John Dennem, Karina Bañuelos, Cheyenne Seneca, Gloryanna Varlerio-Leonce, Christina Tlatilpa Inong, Janet King

Publication Year: 2023

Last Updated:

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Keywords: Social Determinants of Health

 

Short Abstract: Background It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others.

 

Abstract: Background It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others. Hundreds of years across many generations have taught that culture-based activities and interventions improve Native/Indigenous health and wellbeing. We explore if increased Native American culture/cultural connectedness is associated with better mental health/well-being and physical health. Methods We analyzed data from a two-phased study (N = 259 and N = 102) of 361 urban Native Americans in California (2018–2021). The 29 items validated Cultural Connectedness Scale-California (CCS-CA) measured Native culture/cultural connectedness. Mental health/well-being and physical health were assessed using the: modified Herth Hope Index (mHHI), Satisfaction with Life (SWL), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R-10), Substance Abuse (CAGE-AID), and Health Related Quality of Life (HRQOL). We conducted Pearson correlations and stepwise regression analyses with CCS-CA as the independent (predictor) variable to explore our main research questions: 1) Is increased Native American/Indigenous culture associated with: 1) better mental health/well-being; and 2) better physical health? Results Increased Native/Indigenous culture (CCS-CA scores) is significantly associated with better mental health/well-being (mHHI, p < .001) and satisfaction with life (SWL, p < .001) predicts good physical health days (HRQOL, p < .001). Increased connection to Native American/Indigenous culture (CCS-CA scores) is significantly associated with decreased risk for depression (CESD-R-10, p < .0) and substance abuse and (CAGE-AID, p < .07). Significant results for culture as protective against risk for substance abuse (CAGE-AID) was most likely affected (p value approaching significance) due to an error in language on the measure (i.e., created double negative). Conclusions Native American/Indigenous culture is a predictor of improved outcomes for mental health/well-being and physical healthy days. Native culture is an important social determinant of health. We add to the evidence that Native/Indigenous culture (i.e., cultural connectedness) be considered an important intervention objective and health-related outcome measure.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120477/pdf/12889_2023_Article_15587.pdf

Type of Resource: Peer-reviewed scientific article

COVID-VISUN: COVID Vulnerability and Impact Summary for Urban Natives March 2023

Email to Request Report: research@ncuih.org

Authors: Alexander Zeymo

Publication Year: 2023

Last Updated: May 26, 2023

Keywords: Covid-19; Infection Disease; Vaccination/Immunization

 

Short Abstract: This is a summary report compiled by NCUIH on the impact of the COVID-19 pandemic in the urban Native American community during the month of March 2023. This report highlights the level and severity of COVID-19 infections in UIO service areas, tracking recent trends in vaccinations, and reviewing recent news and research relevant to the urban AI/AN community. If you would like to have access to this report, please send an email to research@ncuih.org. ***Please be aware, in Section Two, four counties were mistakenly deleted from the analysis. Estimates for the Portland, Omaha, Reno, and Helena service areas may be inaccurate for tables and statistics in Section Two. (07/11/2023)

 

Type of Resource: NCUIH data products

Promoting Ethical Research With American Indian and Alaska Native People Living in Urban Areas

Authors: Nicole P. Yuan, Jami Bartgis, and Deirdre Demers

Publication Year: 2014

Last Updated:

Journal: American Journal of Public Health

Keywords: Data Collection; Health Disparities; Ethical Research

 

Short Abstract: Most health research with American Indian and Alaska Native (AI/AN) people has focused on tribal communities on reservation lands. Few studies have been conducted with AI/AN people living in urban settings despite their documented health disparities compared with other urban populations.

 

Abstract: Most health research with American Indian and Alaska Native (AI/AN) people has focused on tribal communities on reservation lands. Few studies have been conducted with AI/AN people living in urban settings despite their documented health disparities compared with other urban populations. There are unique considerations for working with this population. Engaging key stakeholders, including urban Indian health organization leaders, tribal leaders, research scientists and administrators, and policymakers, is critical to promoting ethical research and enhancing capacity of urban AI/AN communities. Recommendations for their involvement may facilitate an open dialogue and promote the development of implementation strategies. Future collaborations are also necessary for establishing research policies aimed at improving the health of the urban AI/AN population.

 

Source: Link to Original Article.

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Source: https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2014.302027?role=tab

Type of Resource: Peer-reviewed scientific article

Prevalence of Mental Health Disorders and Treatment Utilization among Urban Lesbian, Gay, Bisexual, and Transgender American Indians and Alaska Natives

Authors: Ethel Nicdao et al.

Publication Year: 2023

Last Updated:

Journal: American Indian and Alaska Native Mental Health Research

Keywords: Gender Identity; Mental and Behavioral Health; Sexuality; Treatment Utilization

 

Short Abstract: We examined prevalence of mental health treatment utilization among 447 lesbian, gay, bisexual, transgender, and Two-Spirit (LGBTT-S) American Indian/Alaska Native (AI/AN) adults and the association of mental health treatment utilization with socio-demographic factors, social support, and mental health diagnoses.

 

Abstract: We examined prevalence of mental health treatment utilization among 447 lesbian, gay, bisexual, transgender, and Two-Spirit (LGBTT-S) American Indian/Alaska Native (AI/AN) adults and the association of mental health treatment utilization with socio-demographic factors, social support, and mental health diagnoses. We derived data from the HONOR Project, a multi-site cross-sectional survey of Native LGBTT-S adults from seven U.S. metropolitan cities. Rates of lifetime mental health treatment utilization were higher for women (87%), those who were college educated (84%), and homeowners (92%). Cisgender women and transgender AI/AN adults had a higher prevalence than cisgender men of major depression, generalized anxiety, and panic disorder. Rates of subthreshold and threshold posttraumatic stress disorder were significantly higher for transgender adults. Lower positive social support and higher emotional social support were associated with greater odds of mental health treatment utilization. Mental health diagnoses and lifetime mental health treatment utilization was positively associated.

 

Source: Link to Original Article.

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Source: https://coloradosph.cuanschutz.edu/docs/librariesprovider205/journal_files/vol30/30_1_2023_35_nicdao.pdf

Type of Resource: Peer-reviewed scientific article

Pregnancy Mortality Surveillance System

Authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (CDC)

Publication Year: 2023

Last Updated: March 23, 2023

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Keywords: Awareness; Ethnicity; Health Disparities; Mental and Behavioral Health; Minority Groups; Misclassification of AI/AN; Population Information; Women's Health; Maternal Health; Pregnancy; Reproductive Health

 

Short Abstract: CDC conducts national pregnancy-related mortality surveillance to better understand the risk factors for and causes of pregnancy-related deaths in the United States.

 

Abstract: CDC conducts national pregnancy-related mortality surveillance to better understand the risk factors for and causes of pregnancy-related deaths in the United States. The Pregnancy Mortality Surveillance System (PMSS) defines a pregnancy-related death as a death while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy. Medical epidemiologists review and analyze death records, linked birth records and fetal death records if applicable, and additional available data from all 50 states, New York City, and Washington, DC. PMSS is used to calculate the pregnancy-related mortality ratio, an estimate of the number of pregnancy-related deaths for every 100,000 live births. The birth data used to calculate pregnancy-related mortality ratios were obtained from the National Vital Statistics System (NVSS) via the Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (CDC WONDER).

 

Source: Link to Original Article.

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Source: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm

Type of Resource: Other

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake

Authors: Matt Ignacio, Sabrina Oesterl , Micaela Mercado, Ann Carver, Gilberto Lopez 3, Wendy Wolfersteig 2, Stephanie Ayers, Seol Ki , Kathryn Hamm, Sairam Parthasarathy, Adam Berryhill, Linnea Evans, Samantha Sabo, Chyke Doubeni

Publication Year: 2023

Last Updated: April 2023

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Keywords: Awareness; Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Infection Disease; Minority Groups; Vaccination/Immunization

 

Short Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals.

 

Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942760/

Type of Resource: Peer-reviewed scientific article

Alcoholics Anonymous-Related Benefit for Urban Native Americans: Does Urban Native American Gender Moderate AA Engagement and Outcomes?

Authors: Rosa E. Munoz and J. Scott Tonigan

Publication Year: 2017

Last Updated:

Journal: Alcoholism Treatment Quarterly

Keywords: Gender Identity; Substance Use; Alcoholics Anonymous; Addiction; Moderation

 

Short Abstract: Alcoholics Anonymous (AA) is one of the most commonly accessed resources for individuals seeking to reduce their drinking.

 

Abstract: Alcoholics Anonymous (AA) is one of the most commonly accessed resources for individuals seeking to reduce their drinking. How urban Native Americans fare in AA is only beginning to be investigated in spite of circumstantial evidence suggesting that a majority of treatment-seeking urban Native Americans will receive 12-step treatment. Even less is known about Native American gender differences with regard to AA-related benefit. The current study addressed this gap by investigating urban Native American gender differences in AA attendance rates and outcomes. To this end, as part of two larger NIH-funded studies we recruited 63 Native American men and women and followed them for 9 months in this naturalistic study (n= 35 males, n = 28 females). Urban Native Americans significantly reduced their drinking over the study period, and AA attendance explained, in part, increased abstinence of study participants. No significant differences in AA attendance and drinking outcomes were observed between Native American men and women; however, descriptively men reported greater reductions in hazardous drinking relative to women. Clinical implications and future directions are discussed.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731782/

Type of Resource: Peer-reviewed scientific article

Psychotherapy With American Indians: An Exploration of Therapist-Rated Techniques in Three Urban Clinics

Authors: Mark Beitel et al.

Publication Year: 2018

Last Updated:

Journal: Psychotherapy

Keywords: Mental and Behavioral Health; Psychotherapy;

 

Short Abstract: The aim of the project was to conduct psychotherapy research in American Indian mental health clinics.

 

Abstract: The aim of the project was to conduct psychotherapy research in American Indian mental health clinics. To date, very little psychotherapy research has been conducted in this area. We report the findings from a multisite investigation of psychotherapy techniques used with American Indians. Psychotherapists, working in three American Indian clinics, were asked to self-report the therapeutic interventions that they used in sessions with 93 separate adult American Indian outpatients. Each therapist rated each client exactly once, and thus data on 93 sessions were collected. Therapists’ self-reported technique use with the Multitheoretical List of Therapist Interventions (McCarthy & Barber, 2009). Ratings were made immediately following the delivery of a session. The common factors approach was the most reported approach, followed by person-centered and interpersonal approaches. However, the therapists reported using techniques from all of the main therapeutic approaches. Technique use was affected by client- (demographic and diagnostic), therapist-, and therapy-related variables. This project represents a promising start to systematic psychotherapy research in busy, urban American Indian clinics. Many psychotherapeutic techniques are utilized, and there are many avenues for future research. A replication with client and observer ratings will be an important next step.

 

Source: Link to Original Article.

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Source: http://gonetowar.com/wp-content/uploads/2019/04/AI-Therapy-Techniques.pdf

Type of Resource: Peer-reviewed scientific article

Oral Health Knowledge and the Utilization of Dental Services: A Survey of Urban Native Americans

Authors: Divesh Byrappagari, Megan K. Kemink, and Jessica J. Ray

Publication Year: 2017

Last Updated:

Journal: Journal of Dental and Oral Health

Keywords: Health Care Access; Health Disparities; Dental Utilization; Oral Health Knowledge;

 

Short Abstract: The purpose of this study is to understand the oral health knowledge among the Native American patients of American Indian Health and Family Services and how it affects the utilization of dental care by these patients.

 

Abstract: The purpose of this study is to understand the oral health knowledge among the Native American patients of American Indian Health and Family Services and how it affects the utilization of dental care by these patients. In collaboration with American Indian Health and Family Services, a non-profit health center serving the Native American community of southeastern Michigan, a paper based survey was administered to all the individuals who sought care at the health center. A total of 55 surveys were collected. A majority of the respondents identified themselves as Native American (71%). Analysis revealed that, a majority of respondents were knowledgeable about the importance of brushing (98%), flossing (96%) and diet (78%) to maintain good oral health. About 91% reported that good oral health was very important to them and about half of them reported having good to very good oral health. A large percent of the respondents did not practice good oral hygiene and seek dental care when needed even though they scored high on the knowledge questions. A majority of the respondents reported not seeking dental care in spite of having dental needs (58%) and listed barriers like; cost of dental care (48%), transportation (10%), and inability to take time off from work (10%) among others. The results of the study indicated that good oral health knowledge alone does not translate to better utilization of dental services, and there are other barriers to seeking care.

 

Source: Link to Original Article.

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Source: https://scientonline.org/open-access/oral-health-knowledge-and-the-utilization-of-dental-services-a-survey-of-urban-native-americans.pdf

Type of Resource: Peer-reviewed scientific article