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2.
Curr Oncol ; 28(5): 3705-3716, 2021 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-34590604

RESUMO

Despite a global and nationwide decrease, Native Americans continue to experience high rates of cancer morbidity and mortality. Vaccination is one approach to decrease cancer incidence such as the case of cervical cancer. However, the availability of vaccines does not guarantee uptake, as evident in the Coronavirus 2019 pandemic. Therefore, as we consider current and future cancer vaccines, there are certain considerations to be mindful of to increase uptake among Native Americans such as the incidence of disease, social determinants of health, vaccine hesitancy, and historical exclusion in clinical trials. This paper primarily focuses on human papillomavirus (HPV) and potential vaccines for Native Americans. However, we also aim to inform researchers on factors that influence Native American choices surrounding vaccination and interventions including cancer therapies. We begin by providing an overview of the historical distrust and trauma Native Americans experience, both past and present. In addition, we offer guidance and considerations when engaging with sovereign Tribal Nations in vaccine development and clinical trials in order to increase trust and encourage vaccine uptake.


Assuntos
Vacinas Anticâncer , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Nativos Estadunidenses , Feminino , Humanos , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle
3.
Int J Infect Dis ; 111: 130-137, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34419583

RESUMO

OBJECTIVES: This study describes the changes in lower respiratory tract infection (LRTI) rates from 1998 to 2014 among hospitalized American Indian/Alaska Native (AI/AN) adults residing in Alaska and other Indian Health Service (IHS) regions. METHODS: Age-adjusted hospital discharge rates and rate ratios were calculated from the IHS Direct and Contract Health Services Inpatient Dataset, IHS National Patient Information Reporting System for AI/AN adults ≥18 years, hospitalized at an IHS-operated, tribally operated, or contract hospital with an LRTI-associated diagnosis during 1998-2014. RESULTS: Overall, there were 13 733 LRTI-associated hospitalizations in Alaska (1998-2014), with an age-adjusted rate of 13.7/1000 adults. Among non-Alaska (non-AK) AI/AN, there were a total of 79 170 hospitalizations, with a rate of 8.6/1000 adults. In the pre-PCV7 and pre-PCV13 periods, LRTI rates were higher in Alaska (AK) AI/AN (12.4 and 14.1, respectively) when compared to non-AK AI/AN (10.1 and 9.1, respectively) (P < 0.0001). In the post-PCV7 and post-PCV13 periods, LRTI rates were also higher in AK (13.5 and 15.0, respectively) compared to non-AK (9.2 and 7.3, respectively) (P < 0.0001). CONCLUSIONS: Over the study period, a 26% increase in rates of LRTI among adult AI/AN residing in AK compared with a 38% decrease in rates among AI/AN residing in non-AK were observed. This disparity is likely due to a variety of factors such as tobacco use, crowding, etc. Strategies to reduce LRTI in AI/AN adults are needed.


Assuntos
Nativos do Alasca , Índios Norte-Americanos , Infecções Respiratórias , Adolescente , Adulto , Alaska/epidemiologia , Nativos Estadunidenses , Hospitalização , Humanos , Infecções Respiratórias/epidemiologia , Estados Unidos/epidemiologia , United States Indian Health Service
4.
Front Public Health ; 9: 667926, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34368048

RESUMO

In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019-2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability.


Assuntos
Equidade em Saúde , Índios Norte-Americanos , Nativos Estadunidenses , Agentes Comunitários de Saúde , Humanos , Saúde Pública , Estados Unidos , Recursos Humanos
5.
S D Med ; 74(4): 172-180, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34432963

RESUMO

PROBLEM: Excessive weight and obesity have been identified as the most serious health problems facing American Indian (AI) children. Thirty-eight percent of the preschool and kindergarten children who participated in this study were either overweight or obese. Potential reasons for this prevalence include the physical activity transition of AI people to sedentary lifestyles, in utero exposure to diabetes, and social determinants of health, especially poverty. In 2013, 29.8 percent of single-race AI/Alaska Native people were living in poverty. Childhood trauma and stress have also been linked to obesity. The experience of numerous negative life events in childhood increases the risk for being overweight by age 15. PURPOSE: Early-life home and preschool interventions with children between the ages of five and 14 have a greater impact on preventing childhood obesity, primarily with children who enter kindergarten already overweight. The purpose of this study was to examine the feasibility and preliminary effects of the Strengthening Family Program (SFP) on the physical health (primarily weight) of AI young children. The goal of this study was to promote strong AI families and improve childhood health; however, the nutrition and exercise activities within the SFP were minimal and not adapted to the AI culture. Therefore, a nutrition and exercise program for AI children between the ages of three to five was developed. The primary objective for this study was then revised to evaluate the feasibility and preliminary effects of the newly developed AI physical activity and nutrition adjunct program for preschool and kindergarten children. METHOD: Two 14-week sessions of the SFP were implemented with an AI activity and nutrition program that incorporated curricula from the Eagle Books and Health is Life in Balance. A mixed methods approach was used with a quasi-experimental wait-list control group design. Quantitative data gathered included child BMI pre- and post-intervention. A focus group was then conducted to identify the strengths and weaknesses of the SFP and the AI activity and nutrition program. Results: Twenty-five children participated in either one of two intervention groups or one waitlist control group. The obesity rates of the preschool and kindergarten intervention groups stayed at 14 percent and at 38 percent pre- and post-intervention, respectively. The obesity rates for the waitlist control group, however, increased from 30 percent at pre-test to 50 percent at post-test. Focus group narratives resulted in two categories of strengths (positive child behaviors and meaning to child) and one weakness (adult disconnect). CONCLUSION: Caregiver participation was limited and challenging. Further community-based dialogue is needed to ensure sustainability.


Assuntos
Nativos Estadunidenses , Obesidade Pediátrica , Adolescente , Adulto , Criança , Pré-Escolar , Exercício Físico , Estudos de Viabilidade , Humanos , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Projetos Piloto
7.
S D Med ; 74(9): 408-412, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34461679

RESUMO

INTRODUCTION: American Indians are burdened with a myriad of health disparities. As South Dakota's largest minority population, increasing medical students' experiences with the healthcare of American Indians can play a significant role in helping to alleviate American Indians' health disparities as these future physicians will be better able to predict, detect, and treat the health care needs of this population. METHODS: Survey data from 103 medical students at the University of South Dakota Sanford School of Medicine (SSOM) was collected and analyzed. Demographic information and perceived levels of being informed about American Indians and populations on reservations were collected. Furthermore, medical students' insights on how the SSOM can improve its students' educational experiences with American Indian populations were also collected. RESULTS: Compared to their perceived knowledge of American Indians prior to beginning medical school (26.2 percent), responding medical students believe they became more informed regarding American Indians (61.2 percent) as they progressed through medical school. Fifty-one of the 64 students (80 percent) who answered the open-ended question noted that their medical training would benefit from increased opportunities (including required) with American Indian people, culture, and reservation-based communities. CONCLUSION: There is a desire amongst medical students to increase and require more cultural information and clinical experiences with American Indian people and populations on reservations. Future research is needed to obtain medical student feedback on the newly implemented curriculum and elective opportunities.


Assuntos
Índios Norte-Americanos , Estudantes de Medicina , Nativos Estadunidenses , Currículo , Humanos , Percepção , Faculdades de Medicina
9.
Diabetes ; 70(8): 1603-1616, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34285119

RESUMO

Prospective studies in informative populations are crucial to increasing our knowledge of disease. In this perspective, we describe a half century of studies in an American Indian population that transformed our understanding of kidney disease in type 2 diabetes, now recognized as the leading cause of kidney failure worldwide. Serial examinations conducted for many years that included the collection of data and samples across multiple domains captured an unprecedented volume of clinical, physiologic, morphometric, genomic, and transcriptomic data. This work permitted us to extensively characterize the course and determinants of diabetic kidney disease, its pathophysiologic underpinnings, and important secular trends of urgent concern to populations worldwide, including the emergence of youth-onset type 2 diabetes and its effect on development of diabetic kidney disease in midlife. By combining these data using the tools of integrative biology, we are developing new mechanistic insights into the development and progression of diabetic kidney disease in type 2 diabetes. These insights have already contributed to the identification and successful therapeutic targeting of a novel pathway in DKD. We anticipate that this work will continue to expand our understanding of this complex disease and influence its management in the coming years.


Assuntos
Nativos Estadunidenses , Nefropatias Diabéticas/etnologia , Rim/fisiopatologia , Nefropatias Diabéticas/fisiopatologia , Humanos
10.
AMA J Ethics ; 23(6): E446-455, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212845

RESUMO

Addressing intergenerational trauma remains a public health priority in Native American (NA) communities. Clinicians working with NA patients must express humility, understand local culture, collaborate, and develop an insider's perspective on NA past and present life in order to earn trust. This case considers an NA adolescent suffering from mental distress, possible substance use, and multiple traumas. The commentary argues that trauma-informed therapies are lacking in some current psychiatric and primary care practices in the Indian Health Service and that an interprofessional, trauma-informed approach that considers the interplay between relevant somatic and psychological factors can better motivate patient-centered care. Cultivating safe environments in which interventions are pursued within the patient-clinician therapeutic alliance is key to generating optimal outcomes and healing among NA patients.


Assuntos
Índios Norte-Americanos , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Nativos Estadunidenses , Humanos , Grupos Minoritários , Assistência Centrada no Paciente
11.
Alzheimers Res Ther ; 13(1): 122, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217363

RESUMO

BACKGROUND: Genetic studies have primarily been conducted in European ancestry populations, identifying dozens of loci associated with late-onset Alzheimer's disease (AD). However, much of AD's heritability remains unexplained; as the prevalence of AD varies across populations, the genetic architecture of the disease may also vary by population with the presence of novel variants or loci. METHODS: We conducted genome-wide analyses of AD in a sample of 2565 Caribbean Hispanics to better understand the genetic contribution to AD in this population. Statistical analysis included both admixture mapping and association testing. Evidence for differential gene expression within regions of interest was collected from independent transcriptomic studies comparing AD cases and controls in samples with primarily European ancestry. RESULTS: Our genome-wide association study of AD identified no loci reaching genome-wide significance. However, a genome-wide admixture mapping analysis that tests for association between a haplotype's ancestral origin and AD status detected a genome-wide significant association with chromosome 3q13.11 (103.7-107.7Mb, P = 8.76E-07), driven by a protective effect conferred by the Native American ancestry (OR = 0.58, 95%CI = 0.47-0.73). Within this region, two variants were significantly associated with AD after accounting for the number of independent tests (rs12494162, P = 2.33E-06; rs1731642, P = 6.36E-05). The significant admixture mapping signal is composed of 15 haplotype blocks spanning 5 protein-coding genes (ALCAM, BBX, CBLB, CCDC54, CD47) and four brain-derived topologically associated domains, and includes markers significantly associated with the expression of ALCAM, BBX, CBLB, and CD47 in the brain. ALCAM and BBX were also significantly differentially expressed in the brain between AD cases and controls with European ancestry. CONCLUSION: These results provide multiethnic evidence for a relationship between AD and multiple genes at 3q13.11 and illustrate the utility of leveraging genetic ancestry diversity via admixture mapping for new insights into AD.


Assuntos
Doença de Alzheimer , Cromossomos Humanos Par 3 , Estudo de Associação Genômica Ampla , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/genética , Nativos Estadunidenses , Região do Caribe , Cromossomos Humanos Par 3/genética , Grupo com Ancestrais do Continente Europeu/genética , Predisposição Genética para Doença , Hispano-Americanos/genética , Humanos , Polimorfismo de Nucleotídeo Único
12.
Am J Public Health ; 111(S2): S126-S132, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34314207

RESUMO

Objectives. To determine the impact of disaggregated mortality and health surveillance data on the ability to identify health disparities for American Indian and Alaska Native (AI/AN) subpopulations. Methods. We conducted a systematic review of reporting categories for AI/AN decedents on official death certificates for all 50 US states. Using public data from the 2017-2018 California Health Interview Survey (CHIS), we conducted bivariate and multivariate analyses to assess disparities in health conditions and outcomes for tribally enrolled and non‒tribally enrolled AI/AN persons compared with non-Hispanic Whites. Results. There was no standard for the collection of tribal enrollment data or AI/AN race on death certificates across all 50 states. There were stark differences in the incidence and prevalence of various health risk factors and chronic diseases for the tribally enrolled AI/AN subpopulation, non‒tribally enrolled AI/AN subpopulation, and non-Hispanic White comparison group. Conclusions. The collection of tribal enrollment data in vital statistics and health surveillance systems is necessary to identify and respond to health disparities among AI/AN subpopulations. These efforts must be conducted in partnership with tribal nations and consider Indigenous data sovereignty.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , Causas de Morte , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Inquéritos Epidemiológicos , Mortalidade/tendências , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Vigilância da População , Prevalência , Estados Unidos , Estatísticas Vitais
13.
BMC Public Health ; 21(1): 1466, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34320979

RESUMO

BACKGROUND: American Indian/Alaska Native (AI/AN) populations have been disproportionately affected by chronic respiratory diseases for reasons incompletely understood. Past research into disease disparity using population-based surveys mostly focused on state-specific factors. The present study investigates the independent contributions of AI/AN racial status and other socioeconomic/demographic variables to chronic respiratory disease disparity in an 11-state region with historically high AI/AN representation. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) spanning years 2011-2018, this work provides an updated assessment of disease disparity and potential determinants of respiratory health in AI/AN populations. METHODS: This cross-sectional study used data from the BRFSS survey, 2011-2018. The study population included AI/AN and non-Hispanic white individuals resident in 11 states with increased proportion of AI/AN individuals. The yearly number of respondents averaged 75,029 (62878-87,350) which included approximately 5% AI/AN respondents (4.5-6.3%). We compared the yearly adjusted prevalence for chronic respiratory disease, where disease status was defined by self-reported history of having asthma and/or chronic obstructive pulmonary disease (COPD). Multivariable logistic regression was performed to determine if being AI/AN was independently associated with chronic respiratory disease. Covariates included demographic (age, sex), socioeconomic (marital status, education level, annual household income), and behavioral (smoking, weight morbidity) variables. RESULTS: The AI/AN population consistently displayed higher adjusted prevalence of chronic respiratory disease compared to the non-Hispanic white population. However, the AI/AN race/ethnicity characteristic was not independently associated with chronic respiratory disease (OR, 0.93; 95% CI, 0.79-1.10 in 2017). In contrast, indicators of low socioeconomic status such as annual household income of <$10,000 (OR, 2.02; 95% CI, 1.64-2.49 in 2017) and having less than high school education (OR, 1.37; 95% CI, 1.16-1.63 in 2017) were positively associated with disease. These trends persisted for all years analyzed. CONCLUSIONS: This study highlighted that AI/AN socioeconomic burdens are key determinants of chronic respiratory disease, in addition to well-established risk factors such as smoking and weight morbidity. Disease disparity experienced by the AI/AN population is therefore likely a symptom of disproportionate socioeconomic challenges they face. Further promotion of public health and social service efforts may be able to improve AI/AN health and decrease this disease disparity.


Assuntos
Nativos do Alasca , Índios Norte-Americanos , Nativos Estadunidenses , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Humanos , Estados Unidos
14.
Sleep Health ; 7(4): 459-467, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34284964

RESUMO

OBJECTIVES: This study investigates race-related disparities in sleep duration and quality among diverse young adults during the coronavirus 2019 (COVID-19) pandemic. DESIGN & SETTING: Online cross-sectional study of young adults in the United States in April 2020. PARTICIPANTS: About 547 American Indian/Alaskan Native (AIAN), Asian, Black, Latinx, and White young adults ages 18-25 years. MEASUREMENTS: Participants completed measures of sleep duration and quality, coronavirus victimization distress, depression, age, sex/gender, employment status, essential worker status, student status, residential region, socioeconomic status, concerns about contracting coronavirus and CDC health risks. RESULTS: Black young adults reported the largest disparity in sleep duration and quality. For sleep duration, AIAN, Asian, White, and Latinx young adults reported approximately one additional hour of sleep compared to Black respondents. Mediation analyses suggest that disparities in sleep duration between Asian and Black young adults may be explained by the higher likelihood of Black respondents being essential workers. For sleep quality, Latinx, White, AIAN, and Asian young adults reported higher levels than Black respondents. Including coronavirus victimization distress as an intervening pathway decreased the effect for Asian and White respondents on sleep quality, suggesting that coronavirus victimization distress partially explains Black and Asian, as well as Black and White differences in sleep quality. CONCLUSIONS: Black young adults reported the shortest sleep duration and lowest levels of sleep quality relative to AIAN, Asian, Latinx and White peers. Interpersonal experiences of coronavirus victimization and structural inequities may partially explain disparities during the COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Pandemias , Sono , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Nativos do Alasca/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
15.
Health Psychol ; 40(6): 380-387, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34323540

RESUMO

OBJECTIVE: "Diminishing returns" of socioeconomic status (SES) suggests that higher SES may not confer equivalent health benefits for ethnic minority individuals as compared to White individuals. Little research has tested whether diminishing returns also affects Native Americans. The objective of this study was to determine whether higher SES is associated with lower diabetes risk and longer gestational length in both Native American and White women, and whether SES predicts gestational length indirectly via diabetes risk. METHOD: A sample of 674,014 Native American and White women was drawn from a population-based California cohort of singleton births (2007-2012). Education, public health insurance status, gestational length, and diabetes diagnosis were extracted from a state-maintained birth cohort database. Covariates were age, health behaviors, pregnancy variables, residence rurality, and prepregnancy body mass index. RESULTS: In logistic regression models, the race by SES interaction (both education and insurance status) was associated with diabetes risk. Compared to high-SES White women, high- and low-SES Native American women had highest and equivalent diabetes risk. In path analyses, the race by SES interaction indirectly predicted gestational length through diabetes, ps < .001. For White women, an indirect effect of diabetes was detected, ps < .001, such that higher SES was associated with reduced risk for diabetes and thus longer gestational length. For Native American women, no indirect effect was detected, ps > .067. CONCLUSIONS: Among Native American women, higher SES did not confer protection against diabetes or shorter gestational length. These findings are consistent with the diminishing returns of SES phenomenon. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Nativos Estadunidenses , Diabetes Mellitus , Grupo com Ancestrais do Continente Europeu , Idade Gestacional , Classe Social , Nativos Estadunidenses/estatística & dados numéricos , Diabetes Mellitus/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Gravidez
16.
Prev Chronic Dis ; 18: E55, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081577

RESUMO

The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises.


Assuntos
COVID-19/etnologia , Serviços de Saúde Comunitária/organização & administração , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde , Adolescente , Afro-Americanos/estatística & dados numéricos , Nativos Estadunidenses/estatística & dados numéricos , COVID-19/prevenção & controle , Criança , Doença Crônica/etnologia , Comorbidade , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pandemias , SARS-CoV-2 , Instituições Acadêmicas
17.
JAMA Netw Open ; 4(6): e2112852, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100936

RESUMO

Importance: Food insecurity is prevalent among racial/ethnic minority populations in the US. To date, few studies have examined the association between pre-COVID-19 experiences of food insecurity and COVID-19 infection rates through a race/ethnicity lens. Objective: To examine the associations of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates and the interactions of race/ethnicity and food insecurity, while controlling for demographic, socioeconomic, risk exposure, and geographic confounders. Design, Setting, and Participants: This cross-sectional study examined the associations of race/ethnicity and food insecurity with cumulative COVID-19 infection rates in 3133 US counties, as of July 21 and December 14, 2020. Data were analyzed from November 2020 through March 2021. Exposures: Racial/ethnic minority groups who experienced food insecurity. Main Outcomes and Measures: The dependent variable was COVID-19 infections per 1000 residents. The independent variables of interest were race/ethnicity, food insecurity, and their interactions. Results: Among 3133 US counties, the mean (SD) racial/ethnic composition was 9.0% (14.3%) Black residents, 9.6% (13.8%) Hispanic residents, 2.3% (7.3%) American Indian or Alaska Native residents, 1.7% (3.2%) Asian American or Pacific Islander residents, and 76.1% (20.1%) White residents. The mean (SD) proportion of women was 49.9% (2.3%), and the mean (SD) proportion of individuals aged 65 years or older was 19.3% (4.7%). In these counties, large Black and Hispanic populations were associated with increased COVID-19 infection rates in July 2020. An increase of 1 SD in the percentage of Black and Hispanic residents in a county was associated with an increase in infection rates per 1000 residents of 2.99 (95% CI, 2.04 to 3.94; P < .001) and 2.91 (95% CI, 0.39 to 5.43; P = .02), respectively. By December, a large Black population was no longer associated with increased COVID-19 infection rates. However, a 1-SD increase in the percentage of Black residents in counties with high prevalence of food insecurity was associated with an increase in infections per 1000 residents of 0.90 (95% CI, 0.33 to 1.47; P = .003). Similarly, a 1-SD increase in the percentage of American Indian or Alaska Native residents in counties with high levels of food insecurity was associated with an increase in COVID-19 infections per 1000 residents of 0.57 (95% CI, 0.06 to 1.08; P = .03). By contrast, a 1-SD increase in Hispanic populations in a county remained independently associated with a 5.64 (95% CI, 3.54 to 7.75; P < .001) increase in infection rates per 1000 residents in December 2020 vs 2.91 in July 2020. Furthermore, while a 1-SD increase in the proportion of Asian American or Pacific Islander residents was associated with a decrease in infection rates per 1000 residents of -1.39 (95% CI, -2.29 to 0.49; P = .003), the interaction with food insecurity revealed a similar association (interaction coefficient, -1.48; 95% CI, -2.26 to -0.70; P < .001). Conclusions and Relevance: This study sheds light on the association of race/ethnicity and past experiences of food insecurity with COVID-19 infection rates in the United States. These findings suggest that the channels through which various racial/ethnic minority population concentrations were associated with COVID-19 infection rates were markedly different during the pandemic.


Assuntos
COVID-19/etiologia , Grupos de Populações Continentais , Grupos Étnicos , Insegurança Alimentar , Disparidades nos Níveis de Saúde , Grupos Minoritários , Adulto , Afro-Americanos , Idoso , Nativos Estadunidenses , Americanos Asiáticos , COVID-19/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Grupo com Ancestrais Oceânicos , Pandemias , Prevalência , SARS-CoV-2 , Estados Unidos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34070347

RESUMO

In cross-sectional studies, parental health literacy (HL) is associated with children's oral health. It is unclear, however, whether HL influences pediatric outcomes. We examined the relationship of HL with change over time in parental oral health knowledge, beliefs, and behaviors, as well as pediatric oral health outcomes. We used longitudinal data from a study designed to reduce dental decay in American Indian children (N = 579). At baseline and annually for three years, parents answered questions assessing HL; oral health knowledge, beliefs, and behaviors; and pediatric oral health status. The number of decayed, missing, and filled tooth surfaces (dmfs) was computed based on annual dental evaluations. Linear mixed models showed that HL was significantly associated with all constructs, except dmfs, at their reference time points and persistently across the three-year study period. HL predicted change over time in only one variable, parents' belief that children's oral health is determined by chance or luck. HL is strongly associated with oral health knowledge, beliefs, behaviors, and status prospectively but is not a key driver of change over time in these oral health constructs.


Assuntos
Cárie Dentária , Letramento em Saúde , Nativos Estadunidenses , Criança , Saúde da Criança , Estudos Transversais , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Humanos , Saúde Bucal
19.
BMC Public Health ; 21(1): 1099, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107882

RESUMO

BACKGROUND: Racial discrimination, including microaggressions, contributes to health inequities, yet research on discrimination and microaggressions has focused on single measures without adequate psychometric evaluation. To address this gap, we examined the psychometric performance of three discrimination/microaggression measures among American Indian and Alaska Native (AI/AN) college students in a large Southwestern city. METHODS: Students (N = 347; 65% female; ages 18-65) completed the revised-Everyday Discrimination Scale, Microaggressions Distress Scale, and Experiences of Discrimination measure. The psychometric performance of these measures was evaluated using item response theory and confirmatory factor analyses. Associations of these measures with age, gender, household income, substance use, and self-rated physical health were examined. RESULTS: Discrimination and microaggression items varied from infrequently to almost universally endorsed and each measure was unidimensional and moderately correlated with the other two measures. Most items contributed information about the overall severity of discrimination and collectively provided information across a continuum from everyday microaggressions to physical assault. Greater exposure to discrimination on each measure had small but significant associations with more substance use, lower income, and poorer self-rated physical health. The Experiences of Discrimination measure included more severe forms of discrimination, while the revised-Everyday Discrimination Scale and the Microaggressions Distress Scale represented a wider range of severity. CONCLUSIONS: In clinical practice, these measures can index varying levels of discrimination for AI/ANs, particularly for those in higher educational settings. This study also informs the measurement of racial discrimination and microaggressions more broadly.


Assuntos
Nativos do Alasca , Racismo , Adolescente , Adulto , Idoso , Agressão , Nativos Estadunidenses , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sudoeste dos Estados Unidos , Estudantes , Adulto Jovem
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