Felicia Schanche Hodge, Dr.PH

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Center for American Indian

Research & Education

American Indian/Alaskan Native Population

1996 U.S. Bureau of CensusPopulation Estimates

1996 IHS service population

2.3 million

1.4 million

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More than 550 Federally recognized tribes in the U.S.

American Indian/Alaskan Native Health Services

IHS Service Area - 12 Area Offices

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Service area consists of counties on and near federal Indian reservations

•37 hospitals •64 healthcenters• 5 school health centers•50 health stations•34 urban Indian health projects

• 12 hospitals• 116 health centers• 3 school health centers • 56 health stations• 167 Alaska village clinics

Tribally operated health services

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American Indian/Alaskan Native Health Services(cont.)

• 50% or more reside in urban areas

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• Non - IHS eligible population falling through the cracks

• hard to reach populations

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• acute chronic

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Leading Causes of DeathIHS Service Area 1991-1993

• Diseases of the Heart 116.1

• Malignant neoplasms 80.6

• Accidents 78.0

• Diabetes Mellitus 25.0

• Chronic Liver disease and cirrhosis 23.6

• Cerebrovascular diseases 23.3

(Deaths per 100,000)

Leading Causes of DeathIHS Service Area 1991-1993 (cont.)

• Pneumonia and influenza 19.5

• Suicide 15.2

• Homicide and legal intervention 14.0

• Chronic obstructive pulmonary diseases and allied conditions 12.8

Causes of DeathIHS Service Area 1991-1993

Compared to rates for the U.S. Population,death rates among American Indians are:

465% higher due to alcoholism (703%)*425% higher due to tuberculosis (525%)*184% higher due to accidents (282%)*166% higher due to diabetes (248%)* 46% higher due to suicides ( 89%)*

*excluding 3 areas with problems underreporting death rates for Indians

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• Culture

• Public awareness

• Missed opportunities

• Recruitment strategies

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• Culture

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• fatalism

• fear

• white man’s disease

• introduction of foreign matter

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• Public Awareness

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• Threat is on-going

• Where to obtain health care

• For yourself and your community

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Culturally Competent Outreach

• Culturally sensitive programs

• Utilize community resources

• Educate via Indian way

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• Demographic Barriers

- written materials inappropriate

- not culturally appropriate

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• Social Barriers

- caretakers

- childhood disease

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• Institutional Barrier

- lack of access

- patient / provider communication

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• Missed Opportunities

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• at IHS clinics

• at urban clinics

• at health fairs

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Barriers to Care

• Access to medical care

• Transportation

• Financial limitations

• Cultural barriers

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CAIRE Projects

Smoking Cessation Project

• Data collected from a sample of 1,369 adult Northern California Indian male/female patients at 18 Indian health clinics

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CAIRE Projects

Smoking Cessation Project (cont.)

• Participants completed a self-administered questionnaire designed to assess smoking rates, patterns andattitudes as well as health status

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Smoking and American Indians

•IHS statistics show 2 out of 5 deaths of Indians arerelated to smoking

•Ceremonial vs. Habitual Tobacco Use - Tobacco in American Indian culture

• Estimated that nationwide 50% of American Indians smoke and 41 % of Indian teens smoke

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Smoking and American Indians (cont.)

• Combined chronic alcohol consumption and tobacco use substantially increases the risk of cancer

• Women who smoke may be at a higher risk for developing cervical cancer

• Tobacco control policies

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CAIRE Projects

Cervical Cancer Project

• Data collected from a sample of 413 adult California Indian patients at 8 Indian health clinic sites

• Participants completed a self-administered questionnaire designed to assess cancer screening, knowledge, attitudes and behavior and health status

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CAIRE Projects

Nutrition Project

• Data collected from a sample of 440 adult female heads of households at 8 Indian health clinic sites

• Participants completed a self-reported questionnaire designed to assess patterns of dietary habits, nutrition KAB, and anthropometric measures

CES-D Caseness Rates

Smoking CessationStudy

16cutoff

28cutoff

Nutrition Study 36.2% 13.6%

42.3% 14.7%

Original Study 19% 5%

Cervical CancerStudy 43.0% 15.8%

Depression: CES-D Scale

0

10

20

30

40

50

score score

OriginalStudy

(Radloff)

SmokingCessation

Study

CervicalCancerStudy

NutritionStudy

16 28

Recruitment Strategies

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• Identify gatekeepers

• Utilize Community Health Representatives (CHRs)

• Work from “Inside” not “Outside”

• Utilize community resources

Education Strategies

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• Talking Circles

• Community newsletters

• Community clinics

• Fully explain participation

• Answer all questions

Communication Strategies

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• Body language

• Organization of speech

• Less direct / more generalized

• Talk slower - pauses

• Minimize complaints

Barriers

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• Understand fears

• Address concerns

• Extend family needs

• Money, childcare, transportation

Cultural Considerations

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• Loss of body parts

• Illness beliefs

• Healing ceremonies