Lillian Tom-Orme

Surveillance for Health Behaviors of American Indians and Alaska Natives—Findings From the Behavioral Risk Factor Surveillance System, 2000-2006

The authors compared estimates for cancer risk factors, use of cancer screening tests, health status indicators, and access to care for American Indians and Alaska Natives (AI/ANs) and non‐Hispanic whites (NHWs) in the US and for AI/ANs in 6 Indian Health Service regions.

Metabolic syndrome: prevalence among American Indian and Alaska native people living in the southwestern United States and in Alaska.

BACKGROUND Metabolic syndrome occurs commonly in the United States. The purpose of this study was to measure the prevalence of metabolic syndrome among American Indian and Alaska Native people. METHODS We measured the prevalence rates of metabolic syndrome, as defined by the National Cholesterol Education Program, among four groups of American Indian and Alaska Native people aged 20 years and older. One group was from the southwestern United States (Navajo Nation), and three groups resided within Alaska. Prevalence rates were age-adjusted to the U.S. adult 2000 population and compared to rates for U.S. whites (National Health and Nutrition Examination Survey [NHANES] 1988-1994). RESULTS Among participants from the southwestern United States, metabolic syndrome was found among 43.2% of men and 47.3% of women. Among Alaska Native people, metabolic syndrome was found among 26.5% of men and 31.2% of women. In Alaska, the prevalence rate varied by region, ranging among men from 18.9% (western Alaska) to 35.1% (southeast), and among women from 22.0% (western Alaska) to 38.4 % (southeast). Compared to U.S. whites, American Indian/Alaska Native men and women from all regions except western Alaska were more likely to have metabolic syndrome; men in western Alaska were less likely to have metabolic syndrome than U.S. whites, and the prevalence among women in western Alaska was similar to that of U.S. whites. CONCLUSION The prevalence rate of metabolic syndrome varies widely among different American Indian and Alaska Native populations. Differences paralleled differences in the prevalence rates of diabetes.

Differences in cigarette and smokeless tobacco use among American Indian and Alaska Native people living in Alaska and the Southwest United States.

INTRODUCTION This study analyzed self-reported tobacco use among American Indian and Alaska Native (AI/AN) people enrolled in the Education and Research Towards Health Study in Alaska (n = 3,821) and the Southwest United States (n = 7,505) from 2004 to 2006. METHODS Participants (7,060 women and 4,266 men) completed a computer-assisted self-administered questionnaire on cigarette and smokeless tobacco (ST) use. RESULTS Current use of cigarettes was considerably higher in Alaska than in the Southwest United States (32% vs. 8%). Current ST use was also more common in Alaska than in the Southwest United States (18% vs. 8%). Additionally, smoking was more common among men, younger age, those who were not married, and who only spoke English at home, while ST use was more common among men, those with lower educational attainment and those who spoke an AI/AN language at home (p < .01). Compared with the U.S. general population, AI/AN people living in Alaska were more likely and those living in the Southwest United States were less likely to be current smokers. Rates of ST use, including homemade ST, in both regions were much higher than the U.S. general population. DISCUSSION Tobacco use among AI/AN people in the Southwest United States, who have a tradition of ceremonial tobacco use, was far lower than among Alaska Native people, who do not have a tribal tradition. Tobacco use is a key risk factor for multiple diseases. Reduction of tobacco use is a critical prevention measure to improve the health of AI/AN people.

Associations among Body Mass Index, Waist Circumference, and Health Indicators in American Indian and Alaska Native Adults:

Purpose. Little is known about obesity-related health issues among American Indian and Alaska Native (AIAN) populations. Approach. A large cohort of AIAN people was assembled to evaluate factors associated with health. Setting. The study was conducted in Alaska and on the Navajo Nation. Participants. A total of 11,293 AIAN people were included. Methods. We present data for body mass index (BMI, kg/m2) and waist circumference (cm) to evaluate obesity-related health factors. Results. Overall, 32.4% of the population were overweight (BMI 25-29.9 kg/m2), 47.1% were obese (BMI ≥ 30 kg/m2), and 21.4% were very obese (BMI, ≥ 35 kg/m2). A waist circumference greater than 102 cm for men and greater than 88 cm for women was observed for 41.7% of men and 78.3% of women. Obese people were more likely to perceive their health as fair/poor than nonobese participants (prevalence ratio [PR], 1.91; 95% CI, 1.71-2.14). Participants younger than 30 years were three times more likely to perceive their health as being fair or poor when their BMI results were 35 or greater compared with those whose BMI results were less than 25 kg/m2. A larger BMI was associated with having multiple medical conditions, fewer hours of vigorous activity, and more hours of television watching. Conclusions. Given the high rates of obesity in AIAN populations and the association of obesity with other health conditions, it is important to reduce obesity among AIAN people.

Arthritis prevalence and associations in American Indian and Alaska native people

OBJECTIVE To investigate the prevalence of arthritis and associations with arthritis in American Indian and Alaska Native populations. METHODS Data on self-reported, doctor-diagnosed arthritis from the baseline visit of 9,968 American Indian and Alaska Native adults from Alaska and the Southwest US were included. The prevalence of arthritis and univariate and multivariate associations between arthritis and demographic characteristics, health-related factors, and treatment are described. RESULTS The prevalence of self-reported arthritis increased with age. The age-sex adjusted prevalence was high in Alaska (26.1%) and low in the Southwest US (16.5%) as compared with the US population (21.5%). In both centers, arthritis was associated with age, lack of employment, chronic medical conditions, and poorer self-reported overall health. Arthritis was associated with female sex in Alaska only, whereas education, marital status, and urban residency were associated with arthritis in the Southwest US. In both centers, self-reported physical health measured by the Short Form 12 Health Survey was lower in people with arthritis, and mental health was not associated with arthritis. More frequent use of antiinflammatory medications was reported with arthritis in both centers, but increased use of traditional medicine and healers were associated with arthritis only in Alaska. CONCLUSION Compared with US rates, the prevalence of self-reported arthritis was higher among Alaska Native people and lower in a Southwest American Indian population. Some factors associated with arthritis differ between the 2 populations.

Physical Activity Patterns of American Indian and Alaskan Native People Living in Alaska and the Southwestern United States

Purpose. Assessment of self-reported physical activity (PA) and effects on health measures. Design. Cross-sectional analysis of baseline data from a cohort study. Setting. Education and Research Towards Health study participants from Alaska and the Southwestern United States enrolled from 2004 to 2007. Subjects. Total of 10,372 American Indian and Alaskan Native people (AI/AN) of at least 18 years. Measures. Participants completed computer-assisted, self-administered questionnaires, and anthropometric and health measurements were taken of each participant. Analysis. Analysis of variance, χ2 tests, and multiple linear regressions were used. Results. Almost 23% of participants reported less than 30 minutes per week of moderate or vigorous activities. Half (49%) reported no vigorous activities. Characteristics associated with more time spent performing vigorous activity were male gender, age less than 40 years, higher income and education levels, and living in a rural area. Almost 70 % of Alaskan participants and 36% of Southwest participants engaged in wild food—harvesting activities. Participants with higher levels of activity had significantly better clinical characteristics (high-density lipoprotein cholesterol, triglycerides, body mass index, and waist circumference). Conclusion. AI/AN people engage in many different physical activities, including traditional harvesting activities. Women had lower levels of PA than men, and participation in vigorous PA was associated with better clinical characteristics. These data can be used to guide health promotion efforts in AI/AN populations.

Impact of hysterectomy and bilateral oophorectomy prevalence on rates of cervical, uterine, and ovarian cancer among American Indian and Alaska Native women, 1999–2004

ObjectiveTo present more accurate incidence rates of cervical, uterine, and ovarian cancer by geographic region in American Indian/Alaska Native (AI/AN) women.MethodsThe authors used data from central cancer registries linked to Indian Health Service (IHS) patient registration database, the Behavioral Risk Factor Surveillance System, IHS National Data Warehouse, and the National Hospital Discharge Survey. Cancer incidence rates were adjusted for hysterectomy and oophorectomy prevalence and presented by region for non-Hispanic White (NHW) and AI/AN women.ResultsAI/AN women had a higher prevalence of hysterectomy (23.1%) compared with NHW women (20.9%). Correcting cancer rates for population-at-risk significantly increased the cancer incidence rates among AI/AN women: 43% for cervical cancer, 67% for uterine cancer, and 37% for ovarian cancer. Risk-correction led to increased differences in cervical cancer incidence between AI/AN and NHW women in certain regions.ConclusionsCurrent reporting of cervical, uterine, and ovarian cancer underestimates the incidence in women at risk and can affect the measure of cancer disparities. Improved cancer surveillance using methodology to correct for population-at-risk may better inform disease control priorities for AI/AN populations.

Construct Validity of the SF-12 among American Indian and Alaska Native People Using Two Known Scoring Methods

Objective. This study evaluated the construct validity of the 12-Item Short Form Survey Instrument (SF-12) in a cohort of American Indian and Alaska Native (AIAN) people. We evaluated two scoring methods to determine their utility in this population. Methods. Participants (N = 11,127) were aged 18 and older, self-identified as AIAN, and had complete SF-12 interview data. Physical and mental health summary scores were calculated using traditional SF-12 (PCS12 and MCS12) and RAND-12 (PHC and MHC) scoring methods. Results. Women scored lower than men on the PHC, PCS12, MHC, and MCS12, as did those with more medical conditions versus none. Those aged 55 and older scored lower on the PHC and PCS12 than younger people. There was no difference in the mean MCS12 score by age and for those 31–55 and aged older than 55 for the MHC. Conclusions. This study demonstrates the construct validity of the PCS12/MCS12 and PHC/MHC in a cohort of AIAN people.

Prevalence of fracture and osteoporosis risk factors in American Indian and Alaska Native people.

Objective. Little is known about prevalence of osteoporosis risk factors among American Indians and Alaska Natives (AIAN). Methods. We included AIAN people (n=8,039) enrolled in the Education and Research Towards Health (EARTH) Study. Prevalence ratios were used to determine cross-sectional associations of risk factors with self-reported bone fractures. Results. There is a high prevalence of multiple risk factors for osteoporosis in AIAN, although the factors that are associated with past fracture vary by gender and geographical area. In general, women who reported a fracture reported more risk behaviors, more than two medical conditions, and low physical activity. Men with higher BMI were less likely to report a fracture. Smoking history was associated with fracture for both genders, though not significantly in all sub-groups. Conclusion. We prevent a high prevalence of risk factors for osteoporosis for AIAN. Future research for osteoporosis risk reduction and prevention in AIAN people is indicated.

Factors associated with response to a follow-up postal questionnaire in a cohort of American Indians.

OBJECTIVE The aim of the study was to collect pilot data on response rates to a follow-up postal questionnaire in a cohort of American Indians living in the Southwestern United States. We tested the effect of questionnaire length on response. METHODS Cohort members were American Indian adults aged 18 and over who completed the baseline study visit. Study participants (N=1587), cohort members who completed the baseline study visit during the first year of enrollment, were randomized into two groups to receive either an 18-page or 3-page follow-up postal questionnaire. Data were collected between October 2005 and March 2006. RESULTS The response rates after two questionnaire mailings and a reminder postcard were significantly higher for the short versus the long (56.2%, 48.1% p= < 0.01) questionnaire. Being female and being aged 50 or older were associated with returning a completed questionnaire. A reminder postcard and second mailing improved response by 11.7% and 13.4% respectively. CONCLUSIONS These results show that a postal questionnaire can be used in a cohort of American Indians living in the Southwest, but suggest that questionnaires should be short and repeat mailings are needed.