Wisconsin Department of Health Services

January 2014 P-00522R

Healthiest Wisconsin 2020 Baseline and Health Disparities ReportAmerican Indian Population

AMERICAN INDIAN POPULATION

Background• Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities

Report • Key points• Data quality

Data• Demographic characteristics• Risk factors• Health outcomes• Protective factors • Youth outcomes• Mental health

ReferencesLinks to additional reports and resourcesContacts

Chapter Outline

Chapter outline

2

AMERICAN INDIAN POPULATION

Report Overview

• This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: http://www.dhs.wisconsin.gov/publications/P0/p00522.pdf

• The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included.

• Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations.

• Technical notes are available at: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

Report overview

3

AMERICAN INDIAN POPULATION

Report Format

Full Report• Format: PDF • Intended use: reference document

Chapters• Format: Annotated PowerPoint slide set• Intended uses: presentations to

– Decision-makers– Service providers– Community leaders– The public

Sample annotated slide

Report overview

4

AMERICAN INDIAN POPULATION

Report Outline

Executive Summary

Section 1: Introduction

Section 2: Demographic overview

Section 3: Health focus areas

Section 4: Infrastructure focus areas

Section 5: Data summaries by population

Section 6: Technical notes

Report overview

5

AMERICAN INDIAN POPULATION

Report Outline: Detail

Section 3: Health focus areas

• Alcohol and other drug use• Chronic disease prevention and management• Communicable diseases• Environmental and occupational health• Healthy growth and development• Injury and violence• Mental health• Nutrition and healthy foods• Oral health• Physical activity• Reproductive and sexual health• Tobacco use and exposure

Section 4: Infrastructure focus areas• Access to health services

Report overview

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AMERICAN INDIAN POPULATION

Report Outline: Detail

Section 5: Data summaries by population

Racial/ethnic minority populationso American Indianso Asianso Blackso Hispanics

  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography

Report overview

7

AMERICAN INDIAN POPULATION

Data notes

• Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: http://www.dhs.wisconsin.gov/publications/P0/p00522y.pdf

• The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution.

• Population estimates that are considered unreliable are excluded.

• Misclassification of racial/ethnic groups may affect the accuracy of rates.

• Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non-Hispanic.

Report overview

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach 8

AMERICAN INDIAN POPULATION

Factors that influence health

Social determinants

of health

Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, http://www.countyhealthrankings.org/our-approach

Report overview

9

AMERICAN INDIAN POPULATION

Historical trauma• Historical trauma is the cumulative exposure to traumatic events

that not only affect the individual exposed, but continue to affect subsequent generations.

• Descendants of those who experienced the traumatic stressor may still exhibit symptoms.

• Populations affected by historical trauma include American Indians, African Americans/Blacks, Hispanics/Latinos, Asians, immigrants and refugees, war veterans, and families experiencing intergenerational poverty.

• Current manifestations may include:• Mistrust of health care, legal, and educational systems; • Higher rates of risk behaviors such as alcohol and drug abuse,

suicide, homicide, and domestic violence; and • Higher rates of chronic diseases.

Report overview

Sources: SAMHSA, Fact Sheet: Historical Trauma http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf, Texas Department of Health Services, Trauma Informed Care Training, http://www.dfps.state.tx.us/Training/Trauma_Informed_Care/page35.asp

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AMERICAN INDIAN POPULATION

Key Points

Summary

• American Indians in Wisconsin are younger than the general population and more likely to live in rural areas.

• American Indians in Wisconsin are more likely to live in poverty, less likely to be in a married couple household, and less likely to have a college degree compared to Whites.

• Key health issues for American Indian adults include: consequences from alcohol use, tobacco use and exposure, asthma, diabetes, intentional injury, premature death from coronary heart disease, and cancer.

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AMERICAN INDIAN POPULATION

Key Points

Summary

• Key health issues for American Indian youth include: obesity, motor vehicle crashes, school violence, and teen pregnancy.

• Better data on American Indians are needed due to small sample size, racial misclassification, and data access issues.

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AMERICAN INDIAN POPULATION

Data quality issues: American Indian population

Data on American Indians are limited due to five major issues:

• Data access

• Inconsistent measures used for race and ethnicity

• Racial misclassification

• Small population size

• Other data quality considerations

Data issues

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AMERICAN INDIAN POPULATION

Demographic and socioeconomic data

14

AMERICAN INDIAN POPULATION

Demographic Characteristics

Wisconsin’s American Indian population is younger than the White population, more rural than other racial/ethnic groups, and increasing in numbers.

• Wisconsin's American Indian population, 2010: 48,511; 0.9% of state total

• Change in the American Indian population, 2000 to 2010: 13% increase

• Median age, 2010: American Indian, 30 years (Whites, 41.5 years) The median age is the age at which half the population is older and half is younger.

• American Indians living in non-metropolitan counties: 41% (Whites, 33%)

Demographics and socioeconomic data

15Sources: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.

AMERICAN INDIAN POPULATION

Socioeconomic data

Wisconsin’s American Indian population has higher poverty rates and less education compared to Whites.

• Median household income in Wisconsin, 2008-2010: American Indians, $35,000 (Whites, $53,000)

• Poverty rate, 2010: American Indian, 29% (Whites, 10%) The poverty rate is the percent living below the federal poverty level.

• Bachelor’s degree or more education (age 25 and older), 2007-2010: American Indian, 11% (Whites, 27%)

• Married-couple households as a percent of family households, 2008-2010: American Indian, 52% (other racial/ethnic groups range from Blacks, 33% to Whites, 82%)

Source: http://www.dhs.wisconsin.gov/health/MinorityHealth/Report.htm and U.S. Census Bureau.16

Demographics and socioeconomic data

AMERICAN INDIAN POPULATION

American Indian population by county, Wisconsin, 2010

Source: U.S. Census, 2010.

American Indian population

American Indians as percent of total population

83.6%

17 - 614

615 - 1,713

1,714 - 3,538

3,539 - 5,968

0.1% - 2.4%

2.5% - 9.3%

9.4% - 16.1%

Demographics and socioeconomic data

17

AMERICAN INDIAN POPULATION

American Indian Tribes in Wisconsin

Source: Great Lakes Inter-Tribal Council, Inc.

Demographics and socioeconomic data

18

AMERICAN INDIAN POPULATION

Poverty rate by race/ethnicity, Wisconsin, 2010

Source: American Community Survey, 2010.

White Black Hispanic Lao/Hmong Other Asian American Indian

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

10% 39% 28% 25% 17% 29%

Total, 13%

Demographics and socioeconomic data

19

AMERICAN INDIAN POPULATION

Risk Factors in Youth and Adults

20

AMERICAN INDIAN POPULATION

Age-adjusted indicators of poor health status among Wisconsin adults by race/ethnicity, 2008-2011

Physical health

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 21

Fair or poor health Physical health not good on at least one day during past month

Of those with at least one day of poor health, percent whose poor health limited usual activities on

at least one day during past month

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

12% 35% 67%31% 49% 68%23% 42% 75%17% 46% 64%32% 78%

WhiteBlackHispanicAsianAmerican Indian

AMERICAN INDIAN POPULATION

Obesity among children (ages 2-4 years) enrolled in WIC, by race/ethnicity, Wisconsin, 2001 and 2010

White Black Hispanic Asian American Indian0%

5%

10%

15%

20%

25%

30%

35%

40%

10% 8% 16% 18% 18%12% 11% 18% 17% 27%

2001 2010

Source: Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance Survey 2010.Note: Based on >= 95th growth chart percentiles for Body Mass Index for age. WIC is the Supplemental Nutrition Program for Women, Infants, and Children.

Nutrition

22

AMERICAN INDIAN POPULATION

Age-adjusted rates of overweight and obesity among Wisconsin adults by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Overweight or Obese Obese0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

63% 27%78% 44%67% 29%45% 71% 38%

WhiteBlackHispanicAsianAmerican Indian

Nutrition

23

AMERICAN INDIAN POPULATION

Rates of early initiation of alcohol and marijuana use among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

Alcohol and other drugs

24

Had first drink before

age 13

Tried mari-juana before

age 13

0%

5%

10%

15%

20%

25%

30%

35%

40%

26% 14%29% 7%19% 6%23% 18%

White Black

Hispanic Asian

American Indian

AMERICAN INDIAN POPULATION

Age-adjusted rates of binge drinking and heavy drinking among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Binge drinking Heavy drinking0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

25% 9%15% 7%21% 28%

WhiteBlackHispanicAmerican Indian

Alcohol and other drugs

25

AMERICAN INDIAN POPULATION

Motor vehicle risk behaviors among Wisconsin high school students, by race/ethnicity, 2007-2011

Injury and violence

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.

Rarely or never wear seat belt Ride with someone who has been drinking alcohol

Drive after drinking alcohol0%

5%

10%

15%

20%

25%

30%

35%

40%

11% 26% 11%26% 27% 6%17% 29% 7%11% 26% 7%14% 34% 21%

White Black

Hispanic Asian

American Indian

26

AMERICAN INDIAN POPULATION

Exposure to school violence among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Injury and violence

27

Carry a weapon at school

Was in a fight at school in past 12

months

Was hit, punched, or kicked in past 12

months

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

17% 19% 24%10% 8% 16%14% 22%22% 23%

White Black

Hispanic Asian

American Indian

AMERICAN INDIAN POPULATION

Estimated prevalence of sexual risk behaviors among Wisconsin high school students by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset.Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Reproductive and sexual health

28

Ever had sex-ual intercourse

Had inter-course before

age 13

Intercourse in last three months

Four or more lifetime part-

ners

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

70% 18% 47% 28%43% 7% 35% 12%32% 20% 9%50% 35% 20%

White Black

Hispanic Asian

American Indian

AMERICAN INDIAN POPULATION

Mental Health

29

AMERICAN INDIAN POPULATION

Protective factors among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

Strongly agree teachers care and give encour-

agement

Strongly agree belong at school

Get mostly A's and B's Strongly agree loved by family and get support

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

65% 74% 40% 89%59% 62% 28% 84%56% 67% 35% 85%61% 66% 41% 79%56% 66% 23% 73%

WhiteBlackHispanicAsianAmerican Indian

Mental health

30

AMERICAN INDIAN POPULATION

Depression among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

Felt sad/hopeless for at least 2 weeks and stopped doing usual activities0%

10%

20%

30%

40%

50%

60%

20% 28% 28% 32% 32%

White Black

Hispanic Asian

American Indian

Mental health

31

AMERICAN INDIAN POPULATION

Suicide risk during past 12 months among Wisconsin high school students, by race/ethnicity, 2007-2011

Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS).

Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Considered suicide

Planned suicide Attempted suicide Suicide attempt with injury

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

13% 10% 5%17% 15% 12%14% 10%20% 13% 9%25% 22% 16%

White Black

Hispanic Asian

American Indian

Mental health

32

AMERICAN INDIAN POPULATION

Suicide deaths, age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, 2008-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates..

Mental health

White Black Hispanic Asian American Indian0

2

4

6

8

10

12

14

16

13.1 7.2 5.9 9.9 14.0

Suicide rate

Rat

e pe

r 100

,000

pop

ulat

ion

33

AMERICAN INDIAN POPULATION

Health Outcomes

34

AMERICAN INDIAN POPULATION

Percentage of coronary heart disease deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

42% 19%73% 54%68% 48%71% 35%73% 50%

White Black

Hispanic Asian

American Indian

Chronic diseases

35

AMERICAN INDIAN POPULATION

Percentage of stroke deaths under the age of 75, by race/ethnicity and sex, Wisconsin, 2006-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.

Male Female0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

28% 15%66% 53%59% 46%68% 43%64% 40%

White Black

Hispanic Asian

American Indian

36

Chronic diseases

AMERICAN INDIAN POPULATION

Age-adjusted rates of high cholesterol and high blood pressure among Wisconsin adults, by race/ethnicity, 2009 and 2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Questions only asked in 2009 and 2011.Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Ever been told you have high cholesterol Ever been diagnosed with high blood pressure0%

10%

20%

30%

40%

50%

60%

31% 25%40% 39%28% 35%23% 38%

White Black

Hispanic American Indian

37

Chronic diseases

AMERICAN INDIAN POPULATION

Age-adjusted rates of diabetes and prediabetes among Wisconsin adults, by race/ethnicity, 2008-2011

Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); 2008-2011 landline-only dataset.Note: Diabetes excludes women who were diagnosed during pregnancy, and does not differentiate between type 1 and type 2 diabetes. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group.

Ever been diagnosed with diabetes Ever been told you have prediabetes0%

5%

10%

15%

20%

25%

7% 6%17% 7%10% 8%16%

WhiteBlackHispanicAmerican Indian

38

Chronic diseases

AMERICAN INDIAN POPULATION

Cancer incidence and mortality (all sites) by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2010

Sources: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Department of Health Services; and National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

Incidence Mortality0

100

200

300

400

500

600

436.9 171.4532.3 243.9322.8 95.0287.7 106.2503.6 229.7

White Black

Hispanic Asian

American Indian

Age-

adju

sted

rate

per

100

,000

pop

ulati

on

39

Chronic diseases

AMERICAN INDIAN POPULATION

Lung and bronchus cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010

Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

White Black Hispanic Asian American Indian0

10

20

30

40

50

60

70

80

90

100

46 70.4 15.3 13.8 85.950.2 53.5 21.3 25.5 33

WisconsinUnited States

Age-

adju

sted

rate

per

100

,000

pop

ulati

on

40

Chronic diseases

AMERICAN INDIAN POPULATION

Female breast cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010

White Black Hispanic Asian American Indian

0

5

10

15

20

25

30

35

21.1 29.1 6.7 9.8 23.222.1 30.8 14.8 11.5 12.5

WisconsinUnited States

Age-

adju

sted

rate

per

100

,000

fem

ale

popu

latio

n

Sources: Source: National Center for Health Statistics. Wisconsin mortality data file 1995-2010, Vital Statistics Cooperative Program, 2013.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

41

Chronic diseases

AMERICAN INDIAN POPULATION

Cervical cancer incidence by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2006-2010

Source: Wisconsin Cancer Reporting System, Office of Health Informatics, Division of Public Health, Wisconsin Department of Health Services.Note: In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

White Black Hispanic Asian American Indian0

2

4

6

8

10

12

14

16

18

20

5.3 9.8 9.9 6.9 18.6

Rate

per

100

,000

fem

ale

popu

latio

n

42

Chronic diseases

AMERICAN INDIAN POPULATION

Prostate cancer mortality by race/ethnicity, age-adjusted rate per 100,000, Wisconsin and United States, 2006-2010

White Black Hispanic Asian American Indian

0

10

20

30

40

50

60

24.1 42.1 12.6 34.821.2 50.9 19.1 10.1 16.9

WisconsinUnited States

Age-

adju

sted

rate

per

100

,000

mal

e p

opul

ation

Source: National Center for Health Statistics, Wisconsin mortality file 1995-2102, Vital Statistics Cooperative Program, 2013.Note: Rate not displayed when based on fewer than 10 cases. In this figure, racial groups include both Hispanics and non-Hispanics; Hispanics include all races.

43

Chronic diseases

AMERICAN INDIAN POPULATION

Alcoholic liver disease deaths by race/ethnicity, age-adjusted rate per 100,000, Wisconsin, 2008-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines; this means a rate may not be presented for every population group.

Alcoholic liver disease deaths0

5

10

15

20

25

30

4.2 3.9 4.5 24.4

WhiteBlackHispanicAmerican Indian

Age-

adju

sted

rate

per

100

,000

pop

ulati

on

44

Chronic diseases

AMERICAN INDIAN POPULATION

Unintentional injury deaths (leading causes) by race/ethnicity, age-adjusted rates per 100,000, Wisconsin, 2008-2010

Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.Note: WISH suppresses small numbers (when cell size is less than 5) to comply with Wisconsin vital records data privacy guidelines.

Falls Motor vehicle crashes Poisoning0

5

10

15

20

25

14 10 89 9 186 7 77 8 X14 22 19

WhiteBlackHispanicAsianAmerican Indian

Age

-adj

uste

d ra

te p

er 1

00,0

00 p

opul

a-tio

n

Injury and violence

45

AMERICAN INDIAN POPULATION

Births to teens ages 15-19 as a percent of all births, by race/ethnicity, Wisconsin, 2000-2010

Perc

ent o

f all

birt

hs

Source:  Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics:  Births to Teens in Wisconsin, 2010.  January 2012.

Black American Indian

Hispanic Laotian/Hmong White Other Asian0%

5%

10%

15%

20%

25%

30%

25% 22% 19% 24% 7% 6%20% 16% 13% 12% 5% 3%

20002010

46

Reproductive and sexual health

AMERICAN INDIAN POPULATIONConfirmed cases of invasive Streptocococcus pneumoniae and group B streptococcal (GBS) disease, rate per 100,000, by race/ethnicity, Wisconsin, 2007-2011

Source: Wisconsin Public Health Information Network, Wisconsin Electronic Disease Surveillance System.Note: Data were not available for Hispanics.

Streptococcus pneumoniae Streptococcal disease, group B0

2

4

6

8

10

12

14

16

18

7.0 4.014.4 6.92.8 1.517.0 10.0

White Black

Asian American Indian

Rate

per

100

,000

pop

ulati

onCommunicable diseases

47

AMERICAN INDIAN POPULATION

References1. 2010 Census Briefs: The American Indian and Alaska Native Population:

http://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf2. University of Wisconsin Population Health Institute. County Health Rankings, 2013.

http://www.countyhealthrankings.org/our-approach 3. Center for Urban Population Health. Milwaukee Health Report, 2011.

http://www.cuph.org/mhr/2011-milwaukee-health-report.pdf 4. LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health

Inequalities in the United States. Joint Center for Political and Economic Studies. http://www.jointcenter.org/sites/default/files/upload/research/files/The%20Economic%20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf

5. Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057–1059. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/

6. Wisconsin Department of Health Services (DHS). Healthiest Wisconsin 2020. http://www.dhs.wisconsin.gov/publications/P0/P00187.pdf

7. Great Lakes Inter-Tribal Epidemiology Center, Data Challenges and Strategies, 2012, unpublished.

8. U.S. Department of Health and Human Services, Gaps and Strategies for Improving AI/AN/NA Data, 2007. http://aspe.hhs.gov/hsp/07/AI-AN-NA-data-gaps/index.htm

48

References

AMERICAN INDIAN POPULATION

9. American Community Survey. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_3YR_S0201&prodType=table

10. American Community Survey Glossary. http://factfinder2.census.gov/help/en/american_factfinder_help.htm#glossary/glossary.htm

11. Centers for Disease Control and Prevention (CDC). Obesity Prevalence Among Low-Income, Preschool-Aged Children - United States, 1998-2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a1.htm

12. CDC. Fact sheets - Underage drinking. http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

13. National Institute on Drug Abuse. Drug Facts: Marijuana. http://www.drugabuse.gov/publications/drugfacts/marijuana

14. CDC. Teen Drivers: Fact Sheet. http://www.cdc.gov/motorvehiclesafety/teen_drivers/teendrivers_factsheet.html

15. CDC. Understanding School Violence. http://www.cdc.gov/violenceprevention/pdf/schoolviolence_factsheet-a.pdf

16. CDC. About School Violence. http://www.cdc.gov/VIOLENCEPREVENTION/youthviolence/schoolviolence/index.html

17. CDC. Sexual Risk Behavior: HIV, STD and Teen Pregnancy Prevention. http://www.cdc.gov/HealthyYouth/sexualbehaviors/

49

References

AMERICAN INDIAN POPULATION

18. CDC. School Connectedness: Strategies for Increasing Protective Factors Among Youth. http://www.cdc.gov/healthyyouth/adolescenthealth/pdf/connectedness.pdf

19. CDC. Youth Risk Behavior Surveillance System. http://apps.nccd.cdc.gov/youthonline/App/Default.aspx

20. Office of Adolescent Health. Mental Health. http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/home.html

21. Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034364/

22. CDC. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. http://www.cdc.gov/nchs/data/databriefs/db37.htm

23. National Institute of Mental Health. Many Teens Considering Suicide Do Not Receive Specialized Mental Health Care. 2012. http://www.nimh.nih.gov/news/science-news/2012/many-teens-considering-suicide-do-not-receive-specialized-mental-health-care.shtml

24. CDC. Health Inequalities Report, 2011. http://www.cdc.gov/mmwr/pdf/other/su6001.pdf

25. CDC. Disparities in Premature Mortality Between High- and Low-Income U.S. Counties. http://www.cdc.gov/pcd/issues/2012/11_0120.htm

26. CDC. Racial/Ethnic and Socioeconomic Disparities in Multiple Risk Factors for Heart Disease and Stroke --- United States, 2003. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a1.htm

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References

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27. DHS. Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Accessed August 2012. http://www.dhs.wisconsin.gov/wish/

28. CDC. Stroke Facts. http://www.cdc.gov/stroke/facts.htm29. Siegel R, et al. CA: A Cancer Journal for Clinicians: Cancer Statistics, 2013. http://

onlinelibrary.wiley.com/doi/10.3322/caac.21166/pdf30. CDC. Vital Signs: Racial Disparities in Breast Cancer Severity — United States, 2005–

2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a5.htm?s_cid=mm6145a5_w

31. Journal of the National Cancer Institute. Racial and Ethnic Disparities in the Receipt of Cancer Treatment. http://jnci.oxfordjournals.org/content/94/5/334.long

32. National Cancer Institute. Fact Sheet: Cancer Health Disparities. http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities

33. United States Cancer Statistics. 1999-2008 Incidence and Mortality Web-based Report. http://apps.nccd.cdc.gov/uscs/toptencancers.aspx

34. CDC. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses - United States, 2000—2004. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm

35. CDC. Racial/Ethnic Disparities and Geographic Differences in Lung Cancer Incidence -- 38 States and the District of Columbia, 1998-2006. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a2.htm

36. American College of Chest Physicians. Racial Disparities in Lung Cancer. http://69.36.35.38/accp/article/chest-physician/racial-disparities-lung-cancer

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References

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37. Bliss A, et al. Lung Cancer Incidence Among American Indians and Alaska Natives in the United States, 1999–2004. http://onlinelibrary.wiley.com/doi/10.1002/cncr.23738/pdf/

38. Wingo PA, et al. Breast Cancer Incidence Among American Indian and Alaska Native Women: U.S., 1999–2004. http://onlinelibrary.wiley.com/doi/10.1002/cncr.23725/pdf

39. Jemal A, et al. The National Cancer Institute. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in Human Papillomavirus (HPV)–associated cancers and HPV. http://jnci.oxfordjournals.org/content/early/2013/01/03/jnci.djs491.full.pdf+html

40. CDC. Cervical Cancer. http://www.cdc.gov/cancer/cervical/41. PubMed Health. Prostate cancer. http://

www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001418/42. National Institutes of Medicine, Medline Plus. Alcoholic Liver Disease. http://

www.nlm.nih.gov/medlineplus/ency/article/000281.htm43. CDC. CDC WONDER. http://wonder.cdc.gov/44. DHS. Wisconsin Interactive Statistics on Health: Injury-related Mortality Module.

http://www.dhs.wisconsin.gov/wish/main/InjuryMortality/InjuryMortality_home.htm45. CDC. Birth Rates for the United States: Teenagers Reach Historic Lows for All Age and

Ethnic Groups. http://www.cdc.gov/nchs/data/databriefs/db89.pdf46. National Center for Health Statistics. Child Trends analysis of 1990-2009 Natality

microdata files from Centers for Disease Control and Prevention. http://datacenter.kidscount.org/data/acrossstates/Rankings.aspx?loct=3&by=v&order=d&ind=4&dtm=252&tf=38

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References

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47. CDC. The Pink Book: Pneumococcal disease. http://www.cdc.gov/vaccines/pubs/pinkbook/pneumo.html

48. The Mayo Clinic. Group B strep disease. http://www.mayoclinic.com/health/group-b-strep/DS01107/DSECTION=risk-factors

49. CDC. Perinatal Group B Streptococcal Disease After Universal Screening Recommendations—United States, 2003—2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a1.htm

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References

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Links to additional reports and resources

• Great Lakes Inter-Tribal Council Epidemiology Center: http://www.glitc.org/programs/epi-home

• United States National Library of Medicine: American Indian Health: http://americanindianhealth.nlm.nih.gov/

• Indian Health Services(IHS): http://www.ihs.gov/

• Wisconsin Tribal Health Centers (DHS website listing): http://www.dhs.wisconsin.gov/localhealth/counties/tribal.htm

• Centers for Disease Control and Prevention (CDC). American Indian & Alaska Native Populations: http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

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Links

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Contacts

Evelyn Cruz, Minority Health OfficerWisconsin Division of Public Health, Office of Policy and Practice AlignmentE-mail: Evelyn2.Cruz@dhs.wisconsin.gov

Karl Pearson, DemographerWisconsin Division of Public Health, Office of Health InformaticsE-mail: KarlT.Pearson@dhs.wisconsin.gov

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Contacts