Follow-up Study Methods for a Longitudinal Cohort of Alaska Native and American Indian People Living within Urban South Central Alaska: The EARTH Study.

Longitudinal data are needed to investigate chronic disease causation and improve prevention efforts for Alaska Native and American Indian (ANAI) people. This paper describes the methods used to conduct follow-up data collection of a longitudinal cohort that enrolled ANAI adults between 2004 and 2006 in south central Alaska. The follow-up study re-examined ANAI participants in a large, urban centre in south central Alaska between 2015 and 2017. Computerized surveys were used to collect self-reported health, lifestyle, physical activity, and diet data. Clinical measurements included blood pressure, fasting blood glucose and lipid panel, urine albumin/creatinine, height, weight, and waist and hip circumference. Participants were provided individual results at the conclusion of their visit. A total of 1320 south central Alaska study participants completed the baseline visit. Study staff attempted to contact all living cohort members for inclusion in the follow-up study. More than 11,000 attempted contacts were made. Of the 637 available for participation, 388 completed the follow-up visit. The proportion of women increased from baseline to follow-up examinations (67 vs. 72%, p < 0.01). Self-reported health status of being married or living as married (46% vs. 39%, p < 0.01), and those reporting being employed or self-employed (55% vs. 47%, p < 0.01) were higher at follow-up when compared to baseline. Almost all participants at follow-up (97%) agreed to long-term storage of biological specimens for future study. Despite demographic differences between the follow-up and baseline cohorts, longitudinal data collected will provide novel insight on chronic disease development and prevention for ANAI people as well as other populations.

Developing a Biomarker Feedback Intervention to Motivate Smoking Cessation During Pregnancy: Phase II MAW Study.

INTRODUCTION: The prevalence of smoking during pregnancy for Alaska Native (AN) women is more than triple that of non-Native Alaska women. In this qualitative study, we solicited input from AN women and others to determine how best to present findings from an earlier study demonstrating a strong correlation between biomarkers for maternal smoking (cotinine) and neonatal exposure to a tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) to motivate cessation. METHODS: We developed a brochure incorporating generalized biomarker information. Using in-depth individual interviews with pregnant and postpartum AN women and partners/family members, we explored applicability and acceptability of the information. Postpartum women, who had participated in the earlier correlation study, additionally received their individual biomarker results. We assessed whether being presented general or individual biomarker information would motivate cessation using content analysis. RESULTS: We conducted 39 interviews: 16 pregnant women, 12 postpartum women, and 11 partners/family members. Overall, participants agreed the biomarker information was new, but understandable as presented. Postpartum women shared that learning their personal results inspired them to want to quit or cut back smoking while pregnant women indicated the generalized correlation information was less helpful in motivating cessation. CONCLUSION: Generalized information about fetal exposure to carcinogens may be more effective in motivating pregnant women to quit smoking when combined with individual cotinine testing. IMPLICATIONS: Using feedback from this study, we refined and are currently evaluating an intervention incorporating generalized correlation information from Phase I and cotinine testing to determine its effectiveness in motivating smoking cessation among pregnant AN women.

Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: A call for prediabetes screening, diagnosis, and referral for intervention.

AIMS: This study estimates incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (henceforth AN) adults living in urban south central Alaska. METHODS: Baseline (2004-2006) and follow-up (2014-2017) surveys, blood samples, and medical chart review data were collected from AN adults living in south central Alaska. We analyzed associations between prevalent risk factors and incident DM and pre-DM using Cox proportional hazards and used multivariable models to identify independent predictors for both DM and pre-DM. RESULTS: Among 379 participants with follow-up data, overall DM incidence was 16.5/1,000 PY; overall pre-DM incidence was 77.6/1,000 PY, with marked differences between men and women. Prevalent cardiometabolic risk factors also varied with greater amounts of overweight in men and greater amounts of obesity in women. Controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. CONCLUSION: Health care providers of AN populations must seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis if we are to alter the epidemiologic course of disease progression in this urban AN population.

Age of initiation of cigarette smoking and smokeless tobacco use among western Alaska Native people: Secondary analysis of the WATCH study.

OBJECTIVE: This study examined self-reported age of tobacco initiation (cigarette smoking and smokeless tobacco [ST] use) and explored potential sex and generational group influences on tobacco use onset among Alaska Native (AN) adult ever tobacco users. METHODS: Secondary analysis of consolidated data from the Western Alaska Tribal Collaborative for Health (WATCH) study comprised 2800 AN adult ever tobacco users (1490 women, 1310 men; mean age = 39.2 years) from two rural western Alaska regions. ST use data were limited to one region. Logistic regression was used to examine potential sex and generational group (age 18-29, 30-49, ≥50) effects on initiation at ≤13 years of age. RESULTS: Thirty-seven percent of the sample reported using any tobacco product by age 13 years. Initiation of any ST use by age 13 was greater than for cigarette smoking (52.7% vs. 18.2%), and women were more likely than men to report initiation of any ST use at ≤13 years (52.6% vs. 38.4%). Nearly one-third of ever smokers (31%) initiated in young adulthood (ages 18-29). For ST use, logistic regression analyses revealed significant sex differences (women more likely to initiate by 13 years of age than men) and generational group effects with younger and middle age groups more likely to report initiation ≤13 years compared to the eldest participants. For smoking, no sex differences were observed but the youngest generational group was more likely to report initiation by age 13 compared to the eldest group. CONCLUSIONS: Earlier age of tobacco initiation is found among younger generations of AN people. Findings highlight the need to focus prevention efforts on initiation of smoking in young adulthood and uptake of ST use among girls.

Women's cancers among Alaska Natives: [corrected] 1969-2003.

INTRODUCTION: Alaska Native (AN) people include multiple, diverse ethnic groups whose ancestors occupied what is now the state of Alaska. Cancer incidence rates among Alaska Native women for breast, cervix, uterus and ovary are presented here. Current rates and trends over time are compared with U.S. White rates. OBJECTIVE: To describe cancer incidence patterns for cancer of the breast, cervix, uterus and ovary among Alaska Native women. METHODS: Cancer incidence data for Alaska Natives are from the Alaska Native Tumor Registry, in Anchorage, Alaska. Incidence rates for U.S. Whites are from the National Cancer Institute Surveillance, Epidemiology, and End Results Program. RESULTS: Breast and cervical cancer incidence rates among Alaska Natives are similar to U.S. White rates, whereas rates for cancer of the uterus and ovary are significantly less than those of U.S. Whites. Thirty-five year trends show increasing rates in breast cancer and decreasing rates of cervical cancer. CONCLUSION: The burden of cancer among Alaska Native women for cancers unique to women is significant. Increasing breast cancer rates among Alaska Natives has greatly contributed to this burden.

Women's cancers among Alaska Natives 1969-2003.

INTRODUCTION: Alaska Native people include multiple, diverse ethnic groups whose ancestors occupied what is now the state of Alaska. Cancer incidence rates among Alaska Native women for breast, cervix, uterus and ovary are presented here. Current rates and trends over time are compared with US White rates. OBJECTIVE: To describe cancer incidence patterns for cancer of the breast, cervix, uterus and ovary among Alaska Native women. METHODS: Cancer incidence data for Alaska Natives are from the Alaska Native Tumor Registry, in Anchorage, Alaska. Incidence rates for US Whites are from the National Cancer Institute Surveillance, Epidemiology, and End Results Program. RESULTS: Breast and cervical cancer incidence rates among Alaska Natives are similar to US White rates, whereas rates for cancer of the uterus and ovary are significantly less than those of US Whites. Thirty-five year trends show increasing rates in breast cancer and decreasing rates of cervical cancer. CONCLUSION: The burden of cancer among Alaska Native women for cancers unique to women is significant. Increasing breast cancer rates among Alaska Natives has greatly contributed to this burden.

High tobacco use prevalence with significant regional and sex differences in smokeless tobacco use among Western Alaska Native people: the WATCH study.

Tobacco use prevalence among Alaska Native (AN) people living in Alaska is greater than the general population prevalence statewide and nationally. Better understanding of regional tobacco use is needed to improve cessation efforts and reduce prevalence. Using self-reported baseline data from the Western Alaska Tribal Collaborative for Health study, we describe tobacco use patterns among AN people in two western Alaska regions. Data were stratified by age group and sex. Dual- and multi-product use in the Yukon-Kuskokwim (Y-K) region was stratified by concurrent vs sequential use. Overall, 87% of the cohort reported having used tobacco. In Norton Sound, cigarette (98%) was the predominant tobacco type. In Y-K 71% smoked, 76% used smokeless tobacco (ST), with 47% reporting use of both products. ST use in Y-K consisted of commercial ST and homemade iqmik. Y-K women reported more ST product use, while men reported more cigarette use. Among dual- and multi-product users, the majority reported concurrent use, with no significant differences between men and women. Distinct regional differences include high smoking prevalence in Norton Sound and frequent use of smoking and ST products in Y-K. Findings support modification of cessation programmes to address regional variations in tobacco use patterns.

Tobacco use during pregnancy among Alaska Natives in western Alaska.

OBJECTIVE: To determine tobacco use rates during pregnancy among Alaska Natives residing on the Yukon-Kuskokwim (Y-K) Delta of western Alaska. Alaska Natives residing in this region use Iqmik, a unique form of smokeless tobacco (ST). STUDY DESIGN: Retrospective cohort study. The medical records of the most recent consecutive 100 Alaska Native women delivering within the Y-K Health Corporation system in 2001 were abstracted for information on tobacco use during this pregnancy and basic demographics. RESULTS: Of the 100 women, 24 did not use tobacco, 55 used ST only, 18 smoked cigarettes only, and 3 used both ST and smoked cigarettes during this pregnancy. Of the 58 who used ST, 22 used Iqmik only, 32 used commercial ST only, and 4 used both. The frequency of ST use increased significantly with age (p=0.007; OR=1.65 per 5-year increase in age, 95% CI 1.15 to 2.36), while the frequency of cigarette smoking tended to decrease with age (p=0.254; OR=0.79 per 5-year increase in age, 95% CI 0.53 to 1.18). CONCLUSION: A high proportion of Alaska Native women use tobacco during pregnancy. The rate of ST use (58%) among pregnant Alaska Native women is markedly higher than the prevalence of ST use (0.5%) among women in the general U.S. population.