COVID-19 Mortality Among American Indian and Alaska Native Persons - 14 States, January-June 2020.

American Indian/Alaska Native (AI/AN) persons experienced disproportionate mortality during the 2009 influenza A(H1N1) pandemic (1,2). Concerns of a similar trend during the coronavirus disease 2019 (COVID-19) pandemic led to the formation of a workgroup* to assess the prevalence of COVID-19 deaths in the AI/AN population. As of December 2, 2020, CDC has reported 2,689 COVID-19-associated deaths among non-Hispanic AI/AN persons in the United States.† A recent analysis found that the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN persons was 3.5 times that among White persons (3). Among 14 participating states, the age-adjusted AI/AN COVID-19 mortality rate (55.8 deaths per 100,000; 95% confidence interval [CI] = 52.5-59.3) was 1.8 (95% CI = 1.7-2.0) times that among White persons (30.3 deaths per 100,000; 95% CI = 29.9-30.7). Although COVID-19 mortality rates increased with age among both AI/AN and White persons, the disparity was largest among those aged 20-49 years. Among persons aged 20-29 years, 30-39 years, and 40-49 years, the COVID-19 mortality rates among AI/AN were 10.5, 11.6, and 8.2 times, respectively, those among White persons. Evidence that AI/AN communities might be at increased risk for COVID-19 illness and death demonstrates the importance of documenting and understanding the reasons for these disparities while developing collaborative approaches with federal, state, municipal, and tribal agencies to minimize the impact of COVID-19 on AI/AN communities. Together, public health partners can plan for medical countermeasures and prevention activities for AI/AN communities.

Tobacco use among American Indian adolescents: protective and risk factors.

PURPOSE: To determine the prevalence of, and identify protective and risk factors for, current tobacco use among American Indian adolescents. METHODS: Data from the Voices of Indian Teens Project were used to determine the prevalence of cigarette and smokeless tobacco (ST) use among a sample of 2390 American Indian adolescents, aged 13 to 20 years. Approximately 49% of the sample were female. Data were collected in Fall 1993 among participants from 10 high schools located in five western American Indian communities. The instrument consisted of scales that assessed psychosocial beliefs, attitudes, and behaviors as well as tobacco use. Logistic regression was used to identify protective and risk factors for tobacco use. A replication subsample was used to test the final models. RESULTS: Approximately 50% of American Indian adolescents in this sample reported some type of cigarette use, and approximately 21% reported using smokeless tobacco. Academic orientation was the only protective factor for cigarette use that replicated in both subsamples. Death/loss and other stressful life events were the risk factors for cigarette and/or ST use that replicated in both subsamples. CONCLUSIONS: The prevalence of tobacco use was high in this sample of American Indian adolescents. Several risk and protective factors were identified, the knowledge of which may inform preventive interventions in this population.

The prevalence of suicidal behaviors among Northern Plains American Indians.

This study examined the prevalence of suicidal behaviors among 1,638 Northern Plains American Indians ages 15-57. Age and gender patterns were investigated as was comorbidity with psychiatric and substance use disorders. Data from a population-based survey indicated that suicidal behaviors were more frequently reported among females than males and among younger respondents than older respondents. In addition, suicidal behaviors were associated with depressive disorders, PTSD, substance abuse/dependence, and violent ideation/aggression. Results underscore the importance of effective and acceptable alcohol, drug, and mental health services in reducing the rates of suicidal behaviors in American Indian communities.

Mapping pathways to services: description of local service systems for American Indian and Alaska Native children by Circles of Care.

The process of describing existing services for American Indian and Alaska Native children with serious emotional disturbance by the Circles of Care strategic planning initiative is overviewed. We explain why service system description is important and how it helped define the role of evaluation within the initiative. Primary goals and methodologies of the service system description are described. Key findings, challenges and opportunities presented by the findings, and impact on the planning process are described.

Feasibility assessment of the service delivery model.

In this component of the evaluation, the Circles of Care grantees assessed the feasibility of their model systems of care. The goal of the Feasibility Assessment was to assure that each model system of care was well designed with careful consideration of project goals, community resources and readiness, cultural competence and measurable outcomes.

Process evaluation: how it works.

Process evaluation helps us to understand the planning process. This predominantly qualitative approach explains how and why decisions are made and activities undertaken. The focus includes feelings and perceptions of program staff. The evaluator's ability to interpret and longitudinally summarize the experience of program staff and community members is critical. Techniques discussed include participant observation, content analysis, situational analysis, in-house surveys, and interviews. By combining sources and methods, a fuller picture of the process is revealed.

Outcomes and accomplishments of the circles of care planning efforts.

This paper presents outcomes and accomplishments of the first round of participating individuals, communities, and grantees of the Circles of Care program (CoC). While accomplishing all CoC program goals, the initiative supported grantees in developing individual service delivery system models and positioned each grantee advantageously for securing funds for future implementation. The process and products as described can now assist others in improving their own systems of care for Indian children, adolescents, and their families.

Stress, trauma, and risky sexual behaviour among American Indians in young adulthood.

This paper examines the relationship of risky sexual behaviour to stress and trauma-often the mediators of the content and structure of everyday life-among young American Indians. School, work, social life, and home life bring about demands and stresses for youth; choices young people make may depend on the quantity and content of those demands. Traumatic events or highly distressing situations may shatter fragile (or even resilient) systems of external and internal support from which youth may draw. American Indians live in some of the most impoverished areas of the country, where everyday life includes a heavy burden of stress and trauma. Using data from a representative sample of youth from a Northern Plains tribe, bivariate and adjusted ordered logit models are used to show that stress and trauma do play a role in the sexual decision-making of young people, especially young women. For example, young women who have experienced a trauma have a 20% probability of having had multiple casual partners in the prior year compared to 9% for those who have not experiences a trauma. Types and levels of stress and trauma also make a difference by gender.

Contextual issues for strategic planning and evaluation of systems of care for American Indian and Alaska Native communities: an introduction to Circles of Care.

This introduction to the evaluation component of the Circles of Care initiative includes background on the nature of the initiative, Center for Mental Health Services support for developing systems of care for youth with emotional disturbances, and an overview of the systems of care approach. The prevalence, unique challenges, and the historical, political, and cultural context of health care delivery for American Indian and Alaska Native peoples are also discussed.

Describing community needs: examples from the Circles of Care initiative.

The assessment of community needs was one of the key foundations of the Circles of Care planning effort. Grantees identified a range of needs at the child, adolescent, family, programmatic, and community levels. This information, along with an emphasis on the importance of each community's history and culture, served as an important guide for each program as they developed their model systems of care.