OBJECTIVE: To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females.
METHODS: Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods.
RESULTS: Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited.
CONCLUSIONS: Findings provide guidance as to where nutrition education and interventions may best support young Native females.

暂无摘要。

American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.

OBJECTIVE: This communication presents the results of defining a tribal health jurisdiction by a combination of tribal affiliation and case address.
METHODS: Through a county-tribal partnership, GIS software and custom code were used to extract tribal data from county data by identifying reservation addresses in county extracts of COVID-19 case records from December 30, 2019, to December 31, 2022 (n = 374,653) and COVID-19 vaccination records from December 1, 2020, to April 18, 2023 (n = 2,355,058).
RESULTS: The tool identified 1.91 times as many case records and 3.76 times as many vaccination records as filtering by tribal affiliation alone.
CONCLUSIONS: This method of identifying communities by patient address, in combination with tribal affiliation and enrollment, can help tribal health jurisdictions attain equitable access to public health data, when done in partnership with a data sharing agreement. This methodology has potential applications for other populations underrepresented in public health and clinical research.

BACKGROUND: Depression among older adults is a pressing public health concern, necessitating accurate assessment tools. The Geriatric Depression Scale (GDS) offers a brief and efficient means of screening depressive symptoms, yet its performance across ethno-racial groups remains understudied. This study aimed to compare the ability of various brief forms of the GDS to detect depressive symptoms and to assess potential ethno-racial differences in symptom endorsement among White, Black/African-American, and American Indian/Alaska Native older adults.
METHODS: Data were obtained from the Wisconsin Alzheimer\'s Disease Research Center (ADRC) clinical cohort, comprising 555 cognitively healthy individuals at risk for dementia. We used participants\' baseline data for this cross-sectional analysis. Depressive symptoms were assessed using multiple brief forms of the GDS, derived from a systematic review and meta-analysis. We examined internal consistency and correlations with global Clinical Dementia Rating (CDR) scores. We conducted Kruskal-Wallis tests and post hoc pairwise comparisons to assess ethno-racial group differences in symptom endorsement.
RESULTS: Descriptive statistics revealed a predominance of female and White participants, with notable representation from Black and American Indian/Alaska Native groups. All GDS versions demonstrated moderate to high internal consistency. Significant positive correlations were observed between GDS scores and global CDR scores. Ethno-racial group differences in depressive symptom endorsement were evident, with Black participants consistently reporting higher levels of symptoms across most GDS versions. However, American Indian/Alaska Native participants endorsed significantly fewer symptoms than Black participants in one GDS version.
CONCLUSIONS: The study highlights the importance of considering ethno-racial differences in depressive symptomatology when assessing older adults. While the GDS demonstrates overall reliability, variations in symptom endorsement across different ethno-racial groups underscore the need for culturally sensitive assessment tools and interventions. Future research should further explore these group differences and develop tailored approaches to depression screening and treatment in diverse older adult populations.

OBJECTIVE: The purpose of this research is to examine the role of justice-involved status on in-hospital mortality among nonelderly adults during the second year of the COVID-19 pandemic.
METHODS: This retrospective cohort study used data from the 2021 State Inpatient Databases for 20 US states, which included discharges from general acute care hospitals among adults aged 18-64 years hospitalized for at least 24 hours. The main outcome was all-cause in-hospital mortality and the primary comparison was justice-involved status. We used logistic regression to estimate the odds ratios and 95% confidence intervals (CIs), with adjustment for sociodemographic factors, Elixhauser comorbidities, COVID-19 diagnosis, admission acuity, other clinical features, metropolitan area, and seasonality. We randomly split the data into a 50% training and 50% validation set. With the latter, we evaluated the performance of our final model.
RESULTS: The study population included 4,712,441 discharges (1.1% justice-involved; mean [SD] age 47.5 [12.8] years; 47.0% women; 63.6% White, 21.8% Black, 11.8% Hispanic, 1.8% Asian/Pacific Islander, and 1.0% American Indian/Alaska Native). Among these, 102,735 in-hospital deaths (2.2%) occurred. In the multivariate analysis, in-hospital mortality was about 40% less likely among justice-involved patients (odds ratios 0.6, 95% CI 0.5-0.7, P value <0.01). The final validated model showed excellent discrimination (area under the curve for the receiver operator characteristic 0.953, 95% CI 0.952-0.954) and good calibration (Brier score 0.014, calibration belt P value .186).
CONCLUSIONS: In this cohort study, justice-involved status was independently associated with lower in-hospital mortality. Future studies should examine preadmission and postdischarge outcomes.

暂无摘要。

BACKGROUND: Alzheimer\'s disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer\'s disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations.
METHODS: Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record.
RESULTS: This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45-64. Females were 1.2 times (95% confidence interval: 1.1-1.2) more likely than males to have a medical visit with an ADRD diagnosis code.
CONCLUSIONS: Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45-64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

暂无摘要。