Accelerating and Strengthening Native American Health Research Through a Collaborative NIH Initiative.

This paper is intended to provide an overview of the considerations that informed the development of a National Institutes of Health funding opportunity to promote health and prevent disease in Native Americans, including American Indian, Alaska Native, and Native Hawaiian communities. NIH Institute staff thoughtfully considered epidemiologic research findings and feedback from constituents regarding the need for more published research overall and stronger prevention efforts to address persistent health concerns affecting many Native communities. This led to the publication of four funding announcements supported by multiple NIH Institutes and one NIH Office. Through the efforts of researchers, tribal leaders, community collaborators, and NIH leadership and staff, a growing body of knowledge regarding culturally informed approaches to supporting health in Native Americans is emerging. This article describes how staff who developed the funding opportunities envisioned a process to support high impact science through ensuring methodological rigor, responsiveness to prevention needs, and respect for community heritage, values, and history with non-Native peoples. In addition, this article highlights the growth of the researchers and collaborators within a community of scientists expanding the knowledge base further by sharing their research resources, instruments, and strategies for engaging in scientific inquiry that meets the needs of Native communities and those of funding organizations.

Prevalence of Fetal Alcohol Spectrum Disorders in 4 US Communities.

Importance: Fetal alcohol spectrum disorders are costly, life-long disabilities. Older data suggested the prevalence of the disorder in the United States was 10 per 1000 children; however, there are few current estimates based on larger, diverse US population samples. Objective: To estimate the prevalence of fetal alcohol spectrum disorders, including fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder, in 4 regions of the United States. Design, Setting, and Participants: Active case ascertainment methods using a cross-sectional design were used to assess children for fetal alcohol spectrum disorders between 2010 and 2016. Children were systematically assessed in the 4 domains that contribute to the fetal alcohol spectrum disorder continuum: dysmorphic features, physical growth, neurobehavioral development, and prenatal alcohol exposure. The settings were 4 communities in the Rocky Mountain, Midwestern, Southeastern, and Pacific Southwestern regions of the United States. First-grade children and their parents or guardians were enrolled. Exposures: Alcohol consumption during pregnancy. Main Outcomes and Measures: Prevalence of fetal alcohol spectrum disorders in the 4 communities was the main outcome. Conservative estimates for the prevalence of the disorder and 95% CIs were calculated using the eligible first-grade population as the denominator. Weighted prevalences and 95% CIs were also estimated, accounting for the sampling schemes and using data restricted to children who received a full evaluation. Results: A total of 6639 children were selected for participation from a population of 13 146 first-graders (boys, 51.9%; mean age, 6.7 years [SD, 0.41] and white maternal race, 79.3%). A total of 222 cases of fetal alcohol spectrum disorders were identified. The conservative prevalence estimates for fetal alcohol spectrum disorders ranged from 11.3 (95% CI, 7.8-15.8) to 50.0 (95% CI, 39.9-61.7) per 1000 children. The weighted prevalence estimates for fetal alcohol spectrum disorders ranged from 31.1 (95% CI, 16.1-54.0) to 98.5 (95% CI, 57.5-139.5) per 1000 children. Conclusions and Relevance: Estimated prevalence of fetal alcohol spectrum disorders among first-graders in 4 US communities ranged from 1.1% to 5.0% using a conservative approach. These findings may represent more accurate US prevalence estimates than previous studies but may not be generalizable to all communities.

Small Sample Research: Considerations Beyond Statistical Power.

Small sample research presents a challenge to current standards of design and analytic approaches and the underlying notions of what constitutes good prevention science. Yet, small sample research is critically important as the research questions posed in small samples often represent serious health concerns in vulnerable and underrepresented populations. This commentary considers the Special Section on small sample research and also highlights additional challenges that arise in small sample research not considered in the Special Section, including generalizability, determining what constitutes knowledge, and ensuring that research designs match community desires. It also points to opportunities afforded by small sample research, such as a focus on and increased understanding of context and the emphasis it may place on alternatives to the randomized clinical trial. The commentary urges the development and adoption of innovative strategies to conduct research with small samples.

Framing ethnic variations in alcohol outcomes from biological pathways to neighborhood context.

BACKGROUND: Health disparities research seeks to eliminate disproportionate negative health outcomes experienced in some racial/ethnic minority groups. This brief review presents findings on factors associated with drinking and alcohol-related problems in racial/ethnic groups. METHODS: Those discussed are as follows: (i) biological pathways to alcohol problems, (ii) gene × stress interactions, (iii) neighborhood disadvantage, stress, and access to alcohol, and (iv) drinking cultures and contexts. RESULTS: These factors and their interrelationships are complex, requiring a multilevel perspective. CONCLUSIONS: The use of interdisciplinary teams and an epigenetic focus are suggested to move the research forward. The application of multilevel research to policy, prevention, and intervention programs may help prioritize combinations of the most promising intervention targets.

Advancing American Indian and Alaska Native substance abuse research: current science and future directions.

American Indians and Alaska Natives (AI/AN) have disproportionately high rates of substance abuse yet there is little empirical research addressing this significant public health problem. This paper is an introduction to a special issue that includes cutting edge science in this research area. We identify several areas that require consideration in this field and indicate how the papers in the special issue address these gaps. These overarching areas of need, which should be considered in any substantive research, include attention to heterogeneity within the population, research that has tangible health benefits, continued work on research methods and strategies, increased focus on strength based and community oriented approaches, and the need for strong research partnerships. The special issue marks a major step forward for AI/AN substance abuse research. However, articles also highlight where more work is need to improve public health in AI/AN communities by addressing identified gap areas.

The influence of Hispanic ethnicity on long-term outcome in three alcohol-treatment modalities.

OBJECTIVE: Prior research has suggested that treatment-seeking Hispanic clients are not likely to affiliate with Alcoholics Anonymous (AA). It was hypothesized that AA 12-step facilitation therapy (TSF) would therefore be less effective than cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) for Hispanics, particularly for those with low acculturation. METHOD: Outcomes for non-Hispanic white (n = 105; 70% male) and Hispanic (n = 100; 80% male) clients at the New Mexico site within Project MATCH were analyzed for evidence of differential treatment response. A pretreatment measure of acculturation to non-Hispanic white culture was available for 80 of the Hispanic clients. RESULTS: Self-identified ethnicity mediated treatment response at distal follow-up, as measured by frequency and intensity of alcohol consumption (p < .02). Hispanics drank with more intensity than did non-Hispanic whites when assigned to TSF; non-Hispanic whites in TSF drank with less frequency than those in the combined CBT and MET conditions. The modest outcome advantage for TSF observed in Project MATCH appears to have been limited to non-Hispanic clients. Contrary to prediction, level of acculturation did not mediate treatment response at proximal (Months 1-6 after treatment) or distal follow-up (Months 7-12). CONCLUSIONS: Ethnic self-identification may interact with treatment outcomes in complex ways that are not directly associated with the factors tapped by commonly used measures of acculturation.