Consistent Honor, Persistent Disadvantage: American Indian and Alaska Native Veteran Health in the National Survey of Veterans.

Objective: To examine self-rated health and activities of daily living (ADLs) limitations among American Indian and Alaska Native (AI/AN) veterans relative to white veterans. Methods: We use the 2010 National Survey of Veterans and limit the sample to veterans who identify as AI/AN or non-Hispanic white. We calculated descriptive statistics, confidence intervals, and used logistic regression. Results: AI/AN veterans are younger, have lower levels of income, and have higher levels of exposure to combat and environmental hazards compared to white veterans. We found that AI/AN veterans are significantly more likely to report fair/poor health controlling for socioeconomic status and experience an ADL controlling for age, health behaviors, socioeconomic status, and military factors. Discussion: The results indicate that AI/AN veterans are a disadvantaged population in terms of their health and disability compared to white veterans. AI/AN veterans may require additional support from family members and/or Veteran Affairs to address ADLs.

Good Health and Wellness: Reflections on Implementing Health Promotion in Indian Country.

In 2014, the Centers for Disease Control and Prevention (CDC) launched "A Comprehensive Approach to Good Health and Wellness in Indian County" (GHWIC) to promote health and chronic disease prevention in tribal communities while facilitating cross-cultural learning and relationship-building. Through GHWIC, CDC aimed to work with American Indian and Alaska Native communities to identify effective health promotion strategies to address chronic disease disparities. Tribal sovereignty, community context, and consideration of tribal histories (e.g., oppression, genocide, and cultural erasure) are key to health improvement efforts and work with tribes. These elements center experience, knowledge, and self-determination to reclaim good health and wellness as Indigenous peoples see it. The Implementation Reflection Project was a qualitative inquiry composed of one-on-one discussions and small group sessions conducted to explore experiences of CDC staff, national partners, and tribal recipients as they implemented GHWIC program activities. The Project documented observations and recommendations for future tribal health funding efforts and identified best practices for effective partnerships with tribes and tribal organizations. Findings centered around tribal experiences with GHWIC, improved program processes, the importance of relationships, and the effects of internal capacity on implementation. Key suggestions for future work with tribal entities included simplifying and clarifying roles, expectations, and administration requirements, and establishing clear and consistent communication between program partners. The approach CDC used with GHWIC recipients was effective and respectful, but room for growth remains. Potential future collaborators in Indian Country should consider these findings when planning health promotion initiatives.

Understanding Risk and Protective Factors Influencing Urban American Indian /Alaska Native Youth Graduation Expectations.

Utilizing data collected by the Monitoring the Future project between 2005-2015, this study assesses the effect of risk and protective factors in shaping the graduation expectations of urban American Indian/Alaska Native (AI/AN) students as compared to their non-Hispanic White (NHW) peers. The responses of nearly 150,000 8th- and 10th-grade students reveal that single race and multi-race AI/AN students experienced 13 of 15 risk factors at higher proportions than NHW students, and 12 of 15 risk factors corresponded to single race AI/AN students and a third of risk factors corresponded to multi-race AI/AN students having higher odds of expecting not to graduate. Additionally, for the majority of the 14 protective factors analyzed, both single race and multi-race AI/AN students showed lower odds of expecting to graduate compared to their NHW peers.