CATCH-UP vaccines: protocol for a randomized controlled trial using the multiphase optimization strategy (MOST) framework to evaluate education interventions to increase COVID-19 vaccine uptake in Oklahoma.

BACKGROUND: Oklahoma's cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma. METHODS: Our study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization). DISCUSSION: Because of Oklahoma's higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.

Impact of e-cigarette use among a cohort of American Indian cigarette smokers: associations with cigarette smoking cessation and cigarette consumption.

INTRODUCTION: Despite American Indian/Alaska Native (AI/AN) people having the highest prevalence of cigarette smoking nationwide, few studies have evaluated e-cigarette use among AI/AN adults who smoke. The primary objective of this observational pilot cohort study was to determine if e-cigarette use is associated with cigarette smoking cessation or reduction among adult AI individuals who smoke. METHODS: In 2016, we collected baseline survey and biomarker data among AI adults who smoke. The survey included questions about cigarette consumption and use of e-cigarettes and biomarkers, such as salivary cotinine markers and exhaled carbon monoxide. After 18 months, we repeated data collection, and asked about changes in cigarette smoking status and cigarettes per day (CPD). Comparisons between groups were performed using the χ2 test, Fisher's exact test or Wilcoxon rank-sum test. RESULTS: Of 375 baseline participants, 214 (57.07%) returned for follow-up and were included in analyses. Of these, 20 (9.3%) reported having stopped cigarette smoking and had biochemical verification of cigarette smoking abstinence. Among those who quit smoking, 15% were baseline e-cigarette users; while among those who continued to smoke at follow-up, about 11% were baseline e-cigarette users. This difference was not statistically significant (p=0.48). Among all those who continued to smoke at follow-up, there was no overall decrease in CPD, nor a significant difference in change in CPD between baseline e-cigarette users and non-users (p=0.98). CONCLUSIONS: E-cigarette use at baseline was not associated with smoking cessation or a change in CPD in this cohort of AI adults who smoke after an 18-month follow-up period.

Extending Research Protections to Tribal Communities.

The history of research in American Indian/Alaska Native (AI/AN) communities has been marked by unethical practices, resulting in mistrust and reluctance to participate in research. Harms are not limited to individual persons-tribal communities experience harmful misrepresentation and generalizations disrespectful of AI/AN groups' heritage, cultures, and beliefs. The Belmont Report's research ethics principles are applied primarily to protect individual research participants. The principles of sovereignty and solidarity are argued to be important concepts in extending Belmont's research protections to tribal communities. Sovereignty, an expression of respect for autonomy at a group level, is the basis for tribal self-determination. The principle of solidarity provides an ethical underpinning for tribes' obligations to protect community interests and culture. Extension of Belmont through these principles should serve to minimize harms to AI/AN groups in research.

Ethical priority of the most actionable system of biomolecules: the metabolome.

The metabolome is a system of small biomolecules (metabolites) and a direct result of human bioculture. Consequently, metabolomics is well poised to impact anthropological and biomedical research for the foreseeable future. Overall, we provide a perspective on the ethical, legal, and social implications (ELSI) of metabolomics, which we argue are often more alarming than those of genomics. Given the current mechanisms to fund research, ELSI beyond human DNA is stifled and in need of considerable attention.

The Hyperechoic Appearance of the Deltoid Muscle on Shoulder Ultrasound Imaging as a Predictor of Diabetes and Prediabetes.

OBJECTIVES: To evaluate whether the ultrasound appearance of the deltoid muscle in diabetic patients differs from that in obese nondiabetic patients. METHODS: Ultrasound images of the deltoid muscle from 137 type 2 diabetic patients (including 13 prediabetic patients) and 49 obese nondiabetic patients were blindly reviewed by 2 musculoskeletal radiologists, and by a third when arbitration was needed, to determine whether the appearance was "normal," "suspected diabetes," or "definite diabetes." Age, sex, race, body mass index (BMI), insulin use, and hemoglobin A1c were analyzed. This retrospective study included patients presenting between October 2005 and November 2017. Statistical analyses included a 2-sided sample t test or Wilcoxon rank sum test and a χ2 or Fisher exact test. Statistical significance was defined as P < .05. RESULTS: The type 2 diabetic patients included 98 women and 39 men aged 29 to 92 years, and the nondiabetic patients included 19 women and 30 men aged 18 to 75 years. A consensus diagnosis of definite diabetes by the musculoskeletal radiologists based on a hyperechoic deltoid was a powerful predictor of diabetes, with a positive predictive value of 89%. A hyperechoic deltoid was also a powerful predictor of prediabetes. Of the 13 prediabetic patients, all had the same hyperechoic appearance of the diabetic deltoid, regardless of BMI. Although obese diabetic patients more often had a diagnosis of definite diabetes, the BMI alone could not explain the increased echogenicity, as obese nondiabetic patients' deltoid muscles did not appear as hyperechoic and were correctly categorized as not having definite diabetes with 82% specificity. CONCLUSIONS: The characteristic hyperechoic deltoid appearance is a strong predictor of both diabetes and prediabetes and differs from that of obese nondiabetic patients.

Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes.

BACKGROUND: The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities. METHODS: In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days. RESULTS: About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them. CONCLUSIONS: Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.

Perceptions of Smoking and Vaping on Weight Control Among Adult American Indians Who Smoke.

Interest in electronic cigarette (EC) use, or vaping, to help control weight is increasing. Many American Indian (AI) populations have a high prevalence of smoking, obesity, and EC use, but their perceptions of EC use for weight control are unknown. In Oklahoma in 2016, 375 AI adults who smoke completed a survey including perceptions about smoking and EC effects on weight control. Only 24% believed that smoking helps control weight, and 8% believed that vaping helps control weight. Perceptions differed by EC use, with ever users more often than never users perceiving that smoking (30% vs 12%, respectively; p < .01) and vaping (10% vs 5%; p = .04) help to control weight. Sex, age group (18-44 years vs 45 + years), education (high school graduate/equivalent vs less than high school), smoking cessation attempt in past year, and likelihood to quit in 6 months were not associated with weight control perceptions for either smoking or vaping. Uncertainty regarding EC effects on weight control was less common among EC ever users compared to never users (41% vs 53%, respectively; p = .04). Most people who did not believe or were uncertain that smoking controls weight also did not believe or were uncertain that vaping controls weight. However, only a minority (29%) of people who believed smoking controls weight also believed that vaping controls weight. Among adult AI who smoke, both smoking and vaping were infrequently perceived as helping to control weight, but such perceptions were reported more frequently among those who ever used ECs.

Sonographic and radiographic findings of posterior tibial tendon dysfunction: a practical step forward.

The purpose of this article is to describe the sonographic and radiographic findings in the diagnosis and treatment of posterior tibial tendon dysfunction. Ultrasound and radiographs play a crucial role in the diagnosis of posterior tibial tendon dysfunction and in imaging the postoperative changes related to posterior tibial tendon dysfunction. Early detection and diagnosis of posterior tibial tendon dysfunction is important in helping to prevent further progression of disease, obviating the need for more invasive and complex procedures.

Continued development of the Rural Active Living Perceived Environmental Support Scale (RALPESS): preliminary evidence for validity among American Indians.

INTRODUCTION: Much of the US adult population does not engage in regular physical activity or meet the recommended guidelines for exercise. Moreover, many rural Americans disproportionately experience lower health status and life expectancy attributed to obesity, poor diet, and lack of physical activity. Evidence supports the role of perceived physical and social-environmental factors as potential influencers of exercise. However, measurement of these influencers, particularly within diverse, rural populations, has been sparse. A substantial number of American Indians live in federally defined rural areas, and many rural American Indians are at elevated risk for being overweight and obese due to physical inactivity. Therefore, this study established the validity and reliability of the Rural Active Living Perceived Environmental Support Scale (RALPESS) within a predominantly rural American Indian sample. METHODS: In this cross-sectional pilot study, the 33-item RALPESS was administered to 130 adults, across 19 rural localities within Oklahoma, who were recruited from community events hosted by local partners of the tribal Head Start program. Confirmatory factor analysis was used to examine the hypothesized factor structure of the RALPESS. RESULTS: Confirmatory factor analysis showed an adequate fit between the hypothesized model and the data. Analyses produced an acceptable χ2 goodness of fit index with two degrees of freedom. The comparative fit index and parsimony goodness of fit index were acceptable. The root mean square error of approximation and its 90% confidence interval were also acceptable. Overall, the RALPESS showed suitable internal consistency for the full measure and its subscales, resulting in Cronbach's alpha between 0.82 and 0.96. CONCLUSIONS: This pilot study produced confirmatory evidence that the RALPESS is likely a valid and reliable tool for use with rural American Indian populations. Continued validation of this scale, particularly in international rural communities, will support further investigation into this important public health issue, and may further efforts towards the development and promotion of effective programming to increase exercise engagement.

Oral microbiome diversity among Cheyenne and Arapaho individuals from Oklahoma.

OBJECTIVES: There is a major ascertainment bias in microbiome research, with individuals of predominately European ancestry living within metropolitan areas dominating most studies. Here we present a study of the salivary microbiome within a North American Indian community. This research is the culmination of four years of collaboration and community engagement with Cheyenne & Arapaho (C&A) tribal members from western Oklahoma. MATERIALS AND METHODS: Using 16S rRNA gene amplification and next-generation sequencing, we generated microbial taxonomic inventories for 37 individuals representing five towns within the C&A tribes. For comparison, we performed the same laboratory techniques on saliva samples from 20 non-native individuals (NNI) from Norman, Oklahoma. RESULTS: The C&A participants differ from the NNI in having reduced within-individual species richness and higher between-individual variation. Unsupervised clustering analyses reveal that three ecological groupings best fit the data, and while C&A individuals include assignments to all three groups, the NNI individuals are assigned to only one group. One of the ecological groups found exclusively among C&A participants was characterized by high abundance of the oral bacterial genus Prevotella. DISCUSSION: The C&A and NNI participants from Oklahoma have notable differences in their microbiome diversity, with a wider range of variation observed among the C&A individuals, including a higher frequency of bacteria implicated in systemic disorders. Overall, this study highlights the importance of engagement with indigenous communities, and the need for an improved understanding of human microbiome diversity among underrepresented groups and those individuals living outside of metropolitan areas.

Obesity, Diabetes, and Birth Outcomes Among American Indians and Alaska Natives.

Objectives To examine the relationships between prepregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), and prepregnancy body mass index, with several adverse birth outcomes: preterm delivery (PTB), low birthweight (LBW), and macrosomia, comparing American Indians and Alaska Natives (AI/AN) with other race/ethnic groups. Methods The sample includes 5,193,386 singleton US first births from 2009-2013. Logistic regression is used to calculate adjusted odds ratios controlling for calendar year, maternal age, education, marital status, Kotelchuck prenatal care index, and child's sex. Results AI/AN have higher rates of diabetes than all other groups, and higher rates of overweight and obesity than whites or Hispanics. Neither overweight nor obesity predict PTB for AI/AN, in contrast to other groups, while diabetes predicts increased odds of PTB for all groups. Being overweight predicts reduced odds of LBW for all groups, but obesity is not predictive of LBW for AI/AN. Diabetes status also does not predict LBW for AI/AN; for other groups, LBW is more likely for women with DM or GDM. Overweight, obesity, DM, and GDM all predict higher odds of macrosomia for all race/ethnic groups. Conclusions for Practice Controlling diabetes in pregnancy, as well as prepregnancy weight gain, may help decrease preterm birth and macrosomia among AI/AN.

Sociocultural Influences on Gambling and Alcohol Use Among Native Americans in the United States.

Gambling opportunities on and near Native American lands have increased in recent decades; yet there is a lack of research examining the patterns of problem gambling and alcohol abuse among Native Americans in the US. Traditional Native American cultural identity may be a protective factor for problem gambling and alcohol abuse among Native Americans. Telephone interviews were conducted with 415 Native American adults aged 18 years and older across the US. The past-year prevalence of gambling among Native Americans is similar to the rate for non-Native Americans in the US (80 vs. 77%). However, Native Americans have over twice the rate of problem gambling as the US sample (18 vs. 8%). Although Native Americans have a lower rate of past-year alcohol use than the US population (47 vs. 68%), they have a somewhat higher rate of alcohol abuse than their US counterparts (5.5 vs. 4.3%). Logistic regression analysis, with problem gambling as the dependent variable, revealed that lower socioeconomic status is significantly associated with an increased odds of problem gambling for Native Americans. Counter to the hypothesis, the higher the score on the Native American orientation, the higher the odds of being a problem gambler. Further, living by the "White way of life" was associated with a decreased odds of being a problem gambler; and perceived gambling convenience was associated with an increased odds of being a problem gambler. None of the Native American factors was significant in predicting alcohol abuse. These findings highlight the need for further investigation into the influence of cultural factors on Native American gambling.

Influence of family structure on obesogenic behaviors and placement of bedroom TVs of American children: National Survey of Children's Health 2007.

OBJECTIVE: To explore the relation between family structure and obesogenic attributes. METHODS: Publicly available data from the 2007 National Survey of Children's Health (n=55,094; 11.6 ± 0.04 years; 51.2% male) was analyzed in fall 2012. Predictor variables included marital status (two-parent biological [referent], two-parent blended, single-mother, and other) and number of children. Outcome variables included the presence of a bedroom television (BTV), elevated television (TV) viewing time, insufficient physical activity, and infrequent family meals. RESULTS: Analysis of family structure revealed 63% biological, 11% blended, and 20% single-mother families. Twenty-three percent of children did not have siblings. When family structure variables were considered independently, children in blended (odds ratio (OR): 1.75; 95% confidence interval (CI) 1.45, 2.10) and single-mother homes (1.49; 1.28, 1.74) had higher odds of BTV. Children in blended families had higher odds of elevated TV viewing time (1.28; 1.08, 1.51). Single-mother homes had higher odds of infrequent family meals (1.28; 1.07, 1.52). Families with ≥ 2 children were less likely to have BTV (0.60; 0.54, 0.66) or elevated TV viewing time (0.74; 0.67, 0.82), and to irregularly dine together (0.89; 0.80, 0.99). CONCLUSION: Diverse family structure was associated with more obesogenic behaviors and environments. The presence of siblings diminished, but did not eliminate, the risk.

Toddler socioemotional behavior in a northern plains Indian tribe: associations with maternal psychosocial well-being.

M.C. Sarche, C.D. Croy, C. Big Crow, C. Mitchell, and P. Spicer (2009) provided first-ever information relating the socioemotional development of American Indian toddlers to the immediate context of their mothers' lives. The current study sought to replicate and build on their earlier work by examining the impact of additional maternal risk factors, identified in previous research with non-American Indian populations, on the development of American Indian toddlers: maternal depression, negative social influences, and mother's feelings of isolation. At 27 months, American Indian mothers (N = 110) completed the Parent Demographic Questionnaire, which measured maternal psychosocial characteristics (e.g., depressed affect, social support, drug and alcohol use, isolation) and demographics. Mothers also completed the Infant-Toddler Social Emotional Assessment (A.S. Carter & M.J. Briggs-Gowan, 2006) and the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (R.R. Abidin, 1995, 1997). Some results replicated the original study, but others did not. Reports of a dysfunctional mother-child relationship related to externalizing and internalizing problems, replicating the earlier study. This study also found associations between a dysfunctional mother-child relationship and socioemotional competence as well as dysregulation. The previous finding of a relationship between American Indian identity and socioemotional competence was supported. Adding the effects of maternal depressed affect and isolation significantly increased prediction of toddler behavior problems.

Rectus abdominus tear in a collegiate cheerleader.

Acute muscle injuries can occur at all skill levels across multiple different sports. Imaging is often used for diagnosis and is necessary for recognizing the extent of injury, complications, and overall prognosis. Ultrasound can be used in diagnosing muscle tears. However, there are less than a dozen documented cases that use ultrasound in the evaluation and diagnosis of a rectus abdominus tear, though the actual number of cases are most likely underreported in the literature. This case discusses an 18-year-old college athlete that suffered a distal rectus abdominus tear after performing a stunt as a cheerleader and her subsequent treatment.

Prevalence of trachoma in a single community, 1975-2007.

BACKGROUND: To determine the change in the prevalence in active trachoma in children in a remote Aboriginal community over a 32-year period. DESIGN: Data used from two cross-sectional studies repeated in the same community 32 years apart. PARTICIPANTS OR SAMPLES: Children aged 5-13 years living in the community. METHODS: Thirty-five mm photographs of the everted upper lid taken in 1975 and digital photographs taken in 2007 were graded using a fine trachoma-grading scheme. MAIN OUTCOME MEASURE: The age-specific prevalence and severity of trachoma was compared at the two time points. RESULTS: Images were available from 82 children in 1975 and from 92 children in 2007. The overall prevalence of active trachoma (trachomatous inflammation follicular and or trachomatous inflammation intense) was 59% in 1975 and in 2007 was significantly lower at 23% (P<0.001). The overall severity grades of active trachoma had also decreased significantly for each sign from 1975 to 2007 (all P values from the rank-sum test were less than 0.001). However, in 2007, there were still some children with severe active trachoma and severe scarring still occurred. CONCLUSION: Although the prevalence and severity of active trachoma in children have decreased significantly over the last 30 years in this community, trachoma still remains a significant public health problem. One third of the children have active trachoma, a figure in excess of the threshold set as a public health problem by the World Health Organization.

American Indians with substance use disorders: treatment needs and comorbid conditions.

BACKGROUND: American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. OBJECTIVES AND METHODS: The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. RESULTS: Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. CONCLUSIONS: Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.

Walking on: celebrating the journeys of Native American adolescents with substance use problems on the winding road to healing.

High rates of substance use and related problems have been long recognized as critical health issues for Native American adolescents. Unfortunately, no manualized interventions address the specific needs of Native American adolescents in a culturally appropriate manner. In 2006, the Cherokee Nation partnered with the University of Colorado to employ a community-based participatory research process to develop an intervention for Native American adolescents with substance use problems. The resulting intervention, Walking On, is an explicit blend of traditional Cherokee healing and spirituality with science-based practices such as cognitive behavioral therapy and contingency management and is designed to address the specific needs and worldviews of Native American adolescents with substance use problems and their families. Each individual and family session includes a brief assessment, a skill-building component, and a ceremony. A Weekly Circle (multifamily group) promotes sobriety and builds a community of healing. Early pilot study results suggest that Walking On is feasible for use in tribal substance abuse treatment programs. While Walking On shows early promise, the intervention will require further study to examine its efficacy.

Imaging findings of a biopsy-proven desmoid tumor of the axilla in a young female.

Desmoid tumors (fibromatoses) are rare but locally aggressive tumors that do not metastasize. They are non-encapsulated, well-differentiated lesions made of fibroblasts and collagen, which mainly appear in the mesentery and abdominal wall. Rarely, these tumors can also occur in breasts, making up approximately 0.2% of all breast neoplasms. Treatment typically includes surgical excision and/or medical management. We describe a case of a 31-year-old female presenting with a mass in her left axilla that was biopsy proven to be a desmoid tumor. In this case report, we discuss the various imaging findings present on ultrasound, mammography, computed tomography, and magnetic resonance imaging.

Isolated distal semitendinosus tendon tear in a collegiate athlete.

Complete distal semitendinosus tendon tears are rare hamstring injuries. They often present with a "pop" followed by delayed pain and swelling. We describe the case of a collegiate athlete with an isolated distal semitendinosus tendon tear diagnosed by MRI and ultrasound after being treated for a stress fracture of the anterior tibial shaft with an intramedullary nail. The tear progressed from partial to complete after 2 weeks of rehabilitation and return to practice. The patient was ultimately successfully treated with semitendinosus tenodesis.