Social contributors to cardiometabolic diseases in indigenous populations: an international Delphi study.

OBJECTIVE: The objective of this study was to identify priority social factors contributing to indigenous cardiometabolic diseases. STUDY DESIGN: A three-round Delphi process was used to consolidate and compare the opinions of 60 experts in indigenous cardiometabolic health from Australia, New Zealand and the United States. METHODS: Round one: three open-ended questions: (i) historical, (ii) economic and (iii) sociocultural factor contributors to cardiometabolic disease risk. Round two: a structured questionnaire based on the results from the first round; items were ranked according to perceived importance. Final round: the items were reranked after receiving the summary feedback. RESULTS: Several key findings were identified: (i) an important historical factor is marginalisation and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that the socio-economic status and educational inequalities are important; and (iii) while consensus was not reached, economic and educational factors were also perceived to be historically influential. CONCLUSION: These findings support the need for multilevel health promotion policy. For example, tackling financial barriers that limit the access to health-promoting resources, combined with improving literacy skills to permit understanding of health education.

Addressing psychosocial issues and problems of co-morbidity for Native American clients with substance abuse problems: a conference proceedings.

This proceedings consists of five papers presented at a conference titled: Psychosocial Issues and Problems of Co-Morbidity for Native American Clients with Substance Abuse Problems. The conference was held June 2-4, 1999, in Albuquerque New Mexico, and was hosted by the Native American Research and Training Center (NARTC) and the National Center for American Indian and Alaska Native Mental Health Research.

Out of harmony: health problems and young Native American men.

Studies of the current health status of healthy young Native American men (American Indians and Alaska Natives) are rare compared with the attention researchers have given the many problems that plague the lives of these young men. Native American men are frequently not included in other studies focusing on men, and information on college-aged, healthy young Native American men is generally not readily available. Despite those drawbacks, this article brings together what is written or known about the health status of young Native American men. The emphasis, based on available information, is placed on some of the major health problems confronting this population.

Emerging epidemic of type 2 diabetes in youth.

This review considers the epidemiologic evidence of an increasing incidence of type 2 diabetes in youth, the classification and diagnostic issues related to diabetes in young populations, pathophysiologic mechanisms relevant to the increasing incidence, the role of genetics and environment, and the community challenge for prevention and treatment. Type 2 diabetes in youth has been recognized to be frequent in populations of native North Americans and to comprise some 30 percent of new cases of diabetes in the 2nd decade of life, largely accounted for by minority populations and associated with obesity. Among Japanese schoolchildren, type 2 diabetes is seven times more common than type 1, and its incidence has increased more than 30-fold over the past 20 years, concomitant with changing food patterns and increasing obesity rates. The forms of diabetes seen in children and youth include typical type 1, occurring in all races; type 2, seen predominantly in minority youth; atypical diabetes, seen as an autosomal dominantly transmitted disorder in African-American populations; and maturity-onset diabetes of the young (MODY), seen rarely and only in Caucasians. Of the nonautoimmune forms of diabetes seen in youth, only type 2 diabetes is increasing in incidence. Proper classification requires consideration of onset (acute/severe versus insidious), ethnicity, family history, presence of obesity, and if necessary, studies of diabetes related autoimmunity. Insulin resistance predicts the development of diabetes in Pima Indians, in offspring of parents with type 2 diabetes, and in other high-risk populations. African-American children and youth have greater insulin responses during glucose tolerance testing and during hyperglycemic clamp study than do whites. There is also evidence of altered beta-cell function preceding the development of hyperglycemia. Of particular interest is the evidence that abnormal fetal and infantile nutrition is associated with the development of type 2 diabetes in adulthood. The thrifty phenotype hypothesis states that poor nutrition in fetal and infant life is detrimental to the development and function of the beta-cells and insulin sensitive tissues, leading to insulin resistance under the stress of obesity. The thrifty genotype hypothesis proposes that defective insulin action in utero results in decreased fetal growth as a conservation mechanism, but at the cost of obesity-induced diabetes in later childhood or adulthood. The vast majority of type 2 diabetes in adults is polygenic and associated with obesity. Monogenic forms (MODY, maternally transmitted mitochondrial mutations) are rare, but are more likely to appear in childhood. Linkage studies of the common polygenic type 2 diabetes have emphasized the heterogeneity of the disorder. The prevention and treatment of type 2 diabetes in children and youth is a daunting challenge because of the enormous behavioral influence, difficulty in reversing obesity, and typical nonadherence in this age-group. The emerging epidemic of type 2 diabetes in the pediatric population, especially among minorities whose proportion in the U.S. population is increasing, presents a serious public health problem. The full effect of this epidemic will be felt as these children become adults and develop the long-term complications of diabetes.

The health of American Indian and Alaska Native women.

By a number of quantity and quality of life measurements, the health and well-being of many American Indian and Alaska Native women falls short of that reported for other women in the United States. Poor socioeconomic conditions, lack of education, cultural barriers, and other factors (some not easily measured) contribute to the enduring poor health status of this population-despite the availability of free health care for many. Free health care alone does not promise a healthy population, especially when the types of free health care are limited, inadequately funded, or have limited focus on preventive care. This paper attempts to pinpoint some of these issues as it relates to the health status of American Indian and Alaska Native women.

Employment barriers and work motivation for Navajo rehabilitation clients.

The Navajo nation provides vocational rehabilitation (VR) services to Navajo clients residing on and off the Navajo reservation. To evaluate motivation among disabled Navajo workers participating in VR programs, this study investigated the sociocultural meanings of work and its importance in the self-identity of contemporary Navajo workers and clients who apply for these services. Selected sociocultural variables that focused on cultural identity and perceptions as well as attitudes towards work were included as part of an assessment designed to predict motivation for employment success. The results of this study suggest that VR counsellors who work with Native American clients should recognize sociocultural history and the cultural perceptions of work as important factors in the rehabilitation and vocational planning process.