Authors: Rhoades DA, Buchwald D
Publication Year: 2003
Last Updated: 2010-01-21 08:14:08
Journal: Journal of the American Geriatrics Society
Keywords: Indians; North American; Alaskan Natives; hypertension; quality of care; aged; urban; Pacific Northwest; obesity; diabetes mellitus; depression; heart disease; renal disease; diuretics; beta-blockers; serum cholesterol; creatinine; retinal screening; urinalyses; electrocardiograms; life-style modification counseling;

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OBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs).

Abstract: OBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs). DESIGN: Retrospective cohort study using medical record review. SETTING: Urban health clinic serving predominantly AI/ANs in the Pacific Northwest. PARTICIPANTS: Five hundred twenty-four AI/ANs aged 50 and older seen between 1994 and 1995. MEASUREMENTS: Frequency of diagnosed hypertension, undiagnosed hypertension, comorbid conditions, hypertension treatment, control, and quality of care. RESULTS: The prevalence of diagnosed hypertension was 38%, and the prevalence of possible undiagnosed hypertension was 23%. Patients with diagnosed hypertension were more likely to be obese (age-adjusted odds ratio (OR) = 3.5), have diabetes mellitus (DM) (OR = 2.2), depression (OR = 1.7), heart disease (OR = 3.8), or renal disease (OR = 5.6) than patients without hypertension. Undiagnosed hypertension was inversely associated with number of health problems (OR = 0.8). Eighty-one percent of diagnosed patients were treated pharmacologically, but no factors associated with nontreatment were identified. Diuretic and beta-blocker usage was low. Patients with DM used angiotensin-converting enzyme inhibitors more frequently than patients without DM (OR = 2.4). Blood pressure was well controlled in 37%, with men being less well controlled than women (OR = 0.5). Serum cholesterol, creatinine, and retinal screening were performed more often than urinalyses or electrocardiograms. Lifestyle-modification counseling was uncommon. Number of health problems was the most common factor associated with screening tests for end-organ disease. CONCLUSION: Few studies have examined the care of older urban AI/ANs. Improvements are needed in adherence to recommendations for the detection, management, and monitoring of hypertension and its complications in older urban AI/ANs.

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Funding: Grants P30AG/15297 and P30AG/15292 from the National Institute of Aging and the National Institute of Nursing Research, National Institutes of Health; P01 HS10854 from the Agency for Healthcare Resear
Code: 80
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Authors: Lipton R., Fruh S. , Allen P
Publication Year: 1994
Last Updated: 2010-01-21 08:14:08
Journal: IHS Primary Care Provider
Keywords: Adult; Aged; Child; Diabetes Mellitus/Epidemiology; Family Characteristics; Female; Health Behavior; Health Surveys; Middle Age; Chronic Disease; Risk Factors; Residence Characteristics; Urban Health 

Short Abstract: The goal of this study was to characterize general health behaviors and risk factors for diabetes and hypertension among a group of urban American Indians.  Simple, descriptive analyses were performed on survey data collected from a sample that included 860 individuals who self-reported at lease one full-blooded American Indian grandparent.

Abstract: Although non-insulin dependent diabetes mellitus is recognized as a leading health problem among American Indians whose health care is provided by tribal or Indian Health Service facilities (mostly rural), few studies have examined the impact of the disease among American Indians living off reservations. The goal of this study was to characterize general health behaviors and risk factors for diabetes and hypertension among a group of urban American Indians. Simple, descriptive analyses were performed on survey data collected from a sample that included 860 individuals who self-reported at least one full-blooded American Indian grandparent. The participants reported a substantial burden of diabetes and hypertension; diagnosed diabetes was acknowledged by 14% of respondents, and 19% reported having hypertension. The prevalence of diabetes increased with increased weight and age. Over half of the respondents had a positive family history of diabetes, two times the national rate. About one-third of the respondents reported using alcohol and a similar proportion were current smokers. We found that 45% of known diabetics in this sample reported a diagnosis of hypertension. Conclusions: The survey results suggest that cardiovascular disease may be at least as much of a risk among urban American Indians with diabetes as among others with diabetes. The burden of chronic disease is clearly not restricted to American Indians living on reservations, and the health needs and services of those residing in urban areas must be addressed.

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Code: 3095
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Authors: Unger JB, Soto C, Baezconde-Garbanati L
Publication Year: 2006
Last Updated: 2010-01-21 08:14:08
Journal: Journal of Adolescent Health
Keywords: American-Indian adolescents; tobacco use; ethnic groups; traditional ceremonial tobacco use; commercial tobacco; advertising imagery; health education; habitual use;

Short Abstract: Background: American-Indian adolescents have the highest tobacco use prevalence of all ethnic groups in the Unites States.  Although much has been written about the role of tobacco in traditional Native-American cultures, little is known about modern-day perceptions of tobacco among American-Indian adolescents. 

Abstract: BACKGROUND: American-Indian adolescents have the highest tobacco use prevalence of all ethnic groups in the United States. Although much has been written about the role of tobacco in traditional Native-American cultures, little is known about modern-day perceptions of tobacco among American-Indian adolescents. METHODS: This study conducted focus groups of 40 American-Indian adolescents in urban and rural areas of Southern California. Participants discussed the role of traditional ceremonial tobacco use in their lives, the use of commercial tobacco as a substitute for sacred tobacco, the perceived safety of traditional versus commercial tobacco, and the perceptions of American-Indian imagery in tobacco advertising. RESULTS: Many American-Indian adolescents may be introduced to traditional tobacco use at early ages. Smoking is viewed as a sign of respect for the elders, but there are acceptable ways for adolescents to participate in ceremonies without inhaling smoke. Commercial cigarettes often are substituted for homegrown tobacco at ceremonies and events. Traditional tobacco was perceived as less dangerous than commercial tobacco because it does not contain chemical additives. However, respondents still perceived that smoking traditional tobacco and breathing tobacco smoke conferred health hazards. Participants found the use of American-Indian imagery in tobacco advertising offensive and stereotypical. Indian casinos were mentioned frequently as places where smoking occurred. CONCLUSIONS: Continued health education efforts are needed to decrease habitual use of commercial tobacco products and secondhand smoke exposure among American-Indian youth. Further research is needed to identify ways for American-Indian youth to participate in their cultural traditions while minimizing their risk for tobacco-related diseases.

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Funding: The California Tobacco-Related Disease Research Program (grant #12RT-0253).
Code: 6
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