A window into pain: American Indian cancer survivors' drawings.

In order to explore the cultural constructs of pain, a series of focus groups were held among adult American Indian (AI) cancer survivors and their caregivers in the Southwest USA. Thirteen focus groups held at four sites (reservation, urban setting, hospital and clinic) elicited information on the barriers to cancer pain management. In response to facilitator questions about cancer pain and existing measurement scales, participants drew pictures to better explain their pain type (i.e., "pounding"), intensity (i.e., "spider web-like"), and other more abstract aspects of their pain episodes. Noting this novel outlet, subsequent groups were prompted for illustrations of pain. A total of 17 drawings were collected from focus group participants. We discuss seven of the drawings that best opened a window into the lived experience of pain, reflected through the eyes of cancer survivors. This study provides evidence that self-expression through color, imagery and written personal accounts provides more accurate depictions of pain for Southwest AI cancer survivors than pain scales alone. It is hypothesized that cultural modes of communication (i.e., storytelling) and intergenerational influences of artwork led to the depiction of pain in drawings. Suggestions for further exploration of the use of the pain drawings for pain assessment in healthcare settings are included.

Cancer-Related Symptom Management Intervention for Southwest American Indians.

There is limited literature related to culturally embedded meanings of cancer and related symptoms among American Indians. A culturally appropriate intervention to improve management of cancer-related symptoms, including pain, depression, fatigue and loss of function, was tested. Two-hundred and twenty-two adult American Indians with cancer were recruited from eight Southwest sites for a randomized clinical trial. The intervention group received tailored education, a toolkit with a video, and participated in discussion sessions on cancer symptom management; the control group received information on dental care. Pre- and post-test questionnaires were administered to control and intervention groups. Measures included socio-demographics, cancer-related symptom management knowledge and behavior, and quality of life measures. Male cancer survivors reported poorer self-assessed health status and lower scores on quality-of-life indicators as compared to female cancer survivors. Significant improvement was reported in symptom management knowledge scores following the intervention: management of pain (p = 0.003), depression (p = 0.004), fatigue (p = 0.0001), and loss of function (p = 0.0001). This study is one of the first to demonstrate a change in physical symptom self-management skills, suggesting culturally appropriate education and interventions can successfully enhance cancer-related symptom management knowledge and practice.

Occurrence and Risk of Metal(loid)s in Thelesperma megapotamicum Tea Plant.

This study reports on the harvesting, ingestion, and contamination of American Indian tea Thelesperma megapotamicum grown on the Navajo Reservation in New Mexico. Uranium (U) and co-metal(loid)s (As, Cd, Cs, Mo, Pb, Se, Th, and V) have contaminated local soil and plants. Tea plants were gathered for analysis near U mining impacted areas. The study collected samples of wild tea plants (n = 14), roots (n = 14), and soil (n = 12) that were analyzed with inductively coupled plasma mass spectrometry. Tea harvesting activities, behavior, and ingestion information were collected via questionnaires. Harvesting took place in community fields and near roadways. Results indicate edible foliage concentration levels for Cd exceeded the World Health Organization (WHO) raw medicinal plant permissible level guidelines. Tea samples collected near high traffic areas had significantly greater Cd and Mo concentrations than those collected near low traffic areas (p < 0.001). Tea sample metal(loid) concentration levels ranged from 0.019-7.916 mg/kg. When compared to established food guidelines including the WHO provisional tolerable weekly intake (PTWI), reference dietary intake, recommended dietary allowance, and the tolerable upper limit (UL), Cd exceeded the WHO guidelines but none exceeded the PTWI nor the UL. These findings warrant improved standardization and establishment of universal guidelines for metal(loid) intake in food.

Metal(loid)s in Cucurbita pepo in a Uranium Mining Impacted Area in Northwestern New Mexico, USA.

More than 500 unreclaimed mines and associated waste sites exist on the Navajo Nation reservation as a result of uranium (U) mining from the 1940s through the 1980s. For this study, the impact of U-mine waste on a common, locally grown crop food was examined. The goal of this site-specific study was to determine metal(loid) concentration levels of arsenic (As), cadmium (Cd), cesium (Cs), molybdenum (Mo), lead (Pb), thorium (Th), U, vanadium (V) and selenium (Se) in Cucurbita pepo Linnaeus (squash), irrigation water, and soil using inductively coupled plasma-mass spectrometry. The concentrations of metal(loid)s were greatest in roots > leaves > edible fruit (p < 0.05), respectively. There were significant differences between metal(loid)s in squash crop plot usage (<5 years versus >30 years) for V (p = 0.001), As (p < 0.001), U (p = 0.002), Cs (p = 0.012), Th (p = 0.040), Mo (p = 0.047), and Cd (p = 0.042). Lead and Cd crop irrigation water concentrations exceeded the United States Environmental Protection Agency (USEPA) Maximum Contaminant Levels for drinking water for those metals. Edible squash concentration levels were 0.116 mg/kg of As, 0.248 mg/kg of Pb, 0.020 mg/kg of Cd, and 0.006 mg/kg of U. Calculated human ingestion of edible squash did not exceed Provisional Tolerable Weekly Intake or Tolerable Upper Limit levels from intake based solely on squash consumption. There does not appear to be a food-ingestion risk from metal(loid)s solely from consumption of squash. Safer access and emphasis on consuming regulated water was highlighted. Food intake recommendations were provided. Continued monitoring, surveillance, and further research are recommended.

Cerebral Autoregulation in Neonates With and Without Congenital Heart Disease.

BACKGROUND: Congenital heart disease (CHD) is a leading birth defect in the United States, affecting about 40 000 neonates each year. Despite efforts to prevent developmental delays, many children with CHD have neurological deficits that last into adulthood, influencing employability, self-care, and quality of life. OBJECTIVE: To determine if neonates with CHD have impaired cerebral autoregulation and poorer neurodevelopmental outcomes compared with healthy controls. METHODS: A total of 44 full-term neonates, 28 with CHD and 16 without, were enrolled in the study. Inclusion criteria included confirmed diagnosis of CHD, stable hemodynamic status, and being no more than 12 days old. Exclusion criteria included intraventricular hemorrhage and intubation. Cerebral autoregulation was determined by measuring regional cerebral oxygenation during a postural change. The Einstein Neonatal Neurobehavioral Assessment Scale was used to measure overall neurodevelopmental outcomes (motor, visual, and auditory functions). RESULTS: Of the 28 neonates with CHD, 8 had single-ventricle physiology. A χ2 analysis indicated no significant difference in impaired cerebral autoregulation between neonates with CHD and controls (P = .38). Neonates with CHD had lower regional cerebral oxygenation than did neonates without CHD (P < .001). Regression analyses with adjustments for cerebral autoregulation indicated that neonates with CHD had poorer total neurodevelopmental outcomes scores (ß = 9.3; P = .02) and motor scores (ß = 7.6; P = .04). CONCLUSION: Preoperative neonates with CHD have poorer developmental outcomes and more hypoxemia than do controls.

Uranium and Associated Heavy Metals in Ovis aries in a Mining Impacted Area in Northwestern New Mexico.

The objective of this study was to determine uranium (U) and other heavy metal (HM) concentrations (As, Cd, Pb, Mo, and Se) in tissue samples collected from sheep (Ovis aries), the primary meat staple on the Navajo reservation in northwestern New Mexico. The study setting was a prime target of U mining, where more than 1100 unreclaimed abandoned U mines and structures remain. The forage and water sources for the sheep in this study were located within 3.2 km of abandoned U mines and structures. Tissue samples from sheep (n = 3), their local forage grasses (n = 24), soil (n = 24), and drinking water (n = 14) sources were collected. The samples were analyzed using Inductively Coupled Plasma-Mass Spectrometry. Results: In general, HMs concentrated more in the roots of forage compared to the above ground parts. The sheep forage samples fell below the National Research Council maximum tolerable concentration (5 mg/kg). The bioaccumulation factor ratio was >1 in several forage samples, ranging from 1.12 to 16.86 for Mo, Cd, and Se. The study findings showed that the concentrations of HMs were greatest in the liver and kidneys. Of the calculated human intake, Se Reference Dietary Intake and Mo Recommended Dietary Allowance were exceeded, but the tolerable upper limits for both were not exceeded. Food intake recommendations informed by research are needed for individuals especially those that may be more sensitive to HMs. Further study with larger sample sizes is needed to explore other impacted communities across the reservation.

HPV awareness among American Indian young adults: implications for health education.

A lack of information about American Indians' awareness and knowledge regarding the human papillomavirus (HPV) exists. This study conducted focus groups among American Indian college students in the Southwest to assess HPV awareness. Fifty-three students participated in the study. Grounded Theory analysis identified common themes. Females reported greater awareness, knowledge and perceived severity of HPV. Frequent misunderstandings about HPV were observed. Males, adolescents and young adults were recommended as intervention targets, with schools and healthcare visits as preferred avenues for education. Recommendations for developing and implementing culturally-competent HPV educational programs for American Indian adolescents and young adults are provided.

Predictors of wellness and American Indians.

Wellness is an important American Indian (AI) concept, understood as being in balance with one's body, mind, and environment. Wellness predictors are reported in this paper within the context of health. A cross-sectional randomized household survey of 457 AI adults at 13 rural health care sites in California was conducted. Measures included wellness perceptions, barriers, health status/health conditions, spirituality, cultural connectivity, high-risk behaviors and abuse history. Statistical analysis obtained the best predictive model for wellness. Predictors of wellness were general health status perception, participation in AI cultural practices and suicide ideation. Significant differences in wellness status were observed depending on experience of adverse events in childhood and adulthood (neglect, physical abuse, and sexual abuse). Cultural connectivity (speaking tribal language, participating in AI practices, and feeling connected to community) was also associated with perceptions of wellness. Recommendations are for culturally-appropriate education and interventions emphasizing community and cultural connectivity for improving wellness status.

Health status and sociodemographic characteristics of the morbidly obese American Indians.

INTRODUCTION: The obesity epidemic has become a health crisis in the United States, particularly for minorities. This article reports on the health status and sociodemographic characteristics of morbidly obese American Indians living in rural areas of California. METHODS: A cross-sectional randomized household study of 457 American Indian adults was implemented at 13 rural reservation sites throughout California. Data collected included sociodemographics, body mass index (BMI), health status, and health problems. Chi-square tests were used to assess statistical differences among categorical data and ANOVA methods were used for normally distributed continuous variables. RESULTS: Nearly a majority of females were morbidly obese (11.6%) or obese (37.3%), while males were significantly represented in the overweight (38%) group (P = .0007). The prevalence of morbid obesity was twice the general population (13% vs. 5.9% respectively); average age was 47 years; 35% spoke their tribal language; 87% were enrolled in a tribe; 46% had 50% or more Indian blood; 42% were married; 29% had less than 12th grade education; and the average monthly household income was $2,126. The average weight of participants was 266 pounds (P < .0001). Morbidly obese adults reported more health problems and physical limitations (P = .003) than adults in other BMI categories. Obesity status and health conditions were significant for those with type 2 diabetes (P = .003), arthritis (P = .04) and hypertension (P = .03). DISCUSSION: The obesity epidemic in the American Indian population is a severe and a multifactorial problem. The high rate of poor health status among this population should be addressed, possibly by programs designed to increase physical activity.

HPV vaccine readiness among American Indian college students.

INTRODUCTION: Young adults experience high rates of human papillomavirus (HPV) infection. This article reports on American Indian (AI) university students' HPV vaccine readiness and female vaccine decision-making. METHODS: Eight focus groups were held with AI students attending four universities. A questionnaire was also administered. Fifty-seven students, 23 males and 34 females, aged 19 to 26 participated. Audio-recorded sessions were transcribed. Common themes were coded and categorized following grounded theory procedures. Statistical tests included chi-square and two sample independent t tests. RESULTS: A significant difference was observed between sexes and HPV risk status (P=.008). Females perceived a higher risk and were more knowledgeable about HPV and the vaccine than males, however, they did not know where to seek information and were less likely to recommend the vaccine to friends. Fifty-two percent of males reported perceived low risk of contracting HPV. Six explanatory factors were identified: low knowledge, access barriers, fear of side effects, culture, adverse historical events, and poor risk perception. DISCUSSION: American Indian female college students are not at a stage of readiness to comply with HPV vaccine recommendations, and need improved access to the HPV vaccine.

Safer Sexual Practices and HIV Screening Behavior among Rural California American Indians.

This paper reports on safer sexual practices and HIV screening behavior among rural California American Indians. Thirteen Indian health clinic registries formed the random household survey sampling frame (N=457). Measures included socio-demographics, safer sexual practices, HIV testing, high-risk behaviors, perception of wellness, general health status, neglect, physical and sexual abuse history. Statistical tests included chi-square and Fisher's exact tests, as well as multiple logistic regression analysis. Respondents who practiced safer sex were younger, not married, reported lower annual income, changed sexual behavior in the last 12 months, were not in a monogamous relationship, and had a higher perception of wellness. Those who were tested for HIV were younger, had at least a high school education, consumed alcohol, had significantly higher suicide ideation and attempts, changed their sexual behavior in the last 12 months, and reported a history of sexual abuse as a child and adult. Very little is known about HIV prevention and screening behaviors in rural American Indian populations. Identifying predictors of unsafe sexual practices and non-HIV testing tendencies help to plan for measures to protect the population from this devastating disease. We make recommendations for implementing HIV prevention education and screenings at American Indian clinics.

A survey of attendees at Native American health care conferences: knowledge, attitudes, and practices about cigarette smoking.

BACKGROUND: Cigarette smoking rates and related health consequences among Native Americans are the highest of any US ethnic group. METHODS: A sample of the attendees at American Indian and Alaska Native health care conferences participated in a survey about cigarette smoking. RESULTS: Of 162 respondents, 11.1% were current smokers, 7.5% of physicians were current smokers, and 80% were lifelong nonsmokers. The majority would ask a smoker to put out cigarettes and would not display ashtrays at home. Nearly all Native American physicians asked their patients about smoking and advised smokers to quit. Respondents were more likely to agree that smoking causes lung cancer (98.7%) as compared to knowing of the associations of smoking with cervical cancer (70.2%), depression (54.5%), and that it is more serious in women (55.2%; P < .01). CONCLUSIONS: Current smoking rates were low, and the physicians advised smokers to quit. However, there was less awareness about women's health problems that relate to cigarette smoking as compared to other health consequences of smoking.

The high incidence of cigarette smoking among American indians of the Northern Plains.

BACKGROUND: American Indians present with high rates of diabetes and smoking. METHODS: A randomized intervention was implemented on 4 Plains Indian reservations. Information on chronic diseases, nutrition, and exercise was presented interactively. In this article, we specifically discuss the high risk behavior of cigarette smoking. RESULTS: Findings indicate an extremely high smoking rate of 57.8% overall, with significantly different rates by age group. Of the participants between the ages of 18 and 24 years, 72.7% were smokers. CONCLUSION: Culturally appropriate smoking prevention, cessation, and control programs are needed to combat the high incidence of cigarette smoking for the American Indians of the Northern Plains.

Sacred tobacco use in Ojibwe communities.

A sacred relationship exists between tobacco and American Indian ceremonial activities and beliefs. This ancient connection continues to play an important role in American Indian communities including the Anishinabe (Ojibwe). Six Ojibwe traditional healers and spiritual leaders described the sacred use of tobacco during interviews. The research provides information on key-informant smoking behaviors, influence of tobacco-industry media, and 3 essential themes: the origin of sacred traditional tobacco; contemporary use and abuse of tobacco; and cultural strengths and meaning of tobacco in Anishinabe (Ojibwe) communities. Health professionals must recognize, be amenable to learn, and understand that sacred tobacco use and smoking commercial cigarette tobacco have separate purposes and functions. The challenge for health professionals, including nurses, is to retain the cultural use and value of tobacco while addressing the abuse and chronic effects of cigarette smoking when providing health care to American Indian clients.

American Indian internet cigarette sales: another avenue for selling tobacco products.

A study conducted by the University of Minnesota found that cigarettes can be purchased on American Indian-owned Internet sites for about one fifth of the price at grocery stores, making this a more convenient, lower-priced, and appealing method of purchasing cigarettes. Researchers and educators are challenged to address this new marketing ploy and to discover ways to curb rising smoking rates in American Indian communities.