Abstract
Feasibility and usability of implementing web-based health promotion programs for American Indian and Alaska Native youth
Christine Markham, PhD1, Stephanie Craig-Rushing, PhD, MPH2, Cornelia Jessen, MA3, Gwenda Gorman4, Jennifer Torres, MPH, CHES5, William Lambert, PhD6, Alexander Prokhorov, MD, PhD7, Leslie Miller8, Kelly Allums-Featherston, PhD9, Robert Addy, PhD5, Melissa Peskin, PhD10 and Ross Shegog, PhD5
(1)University of Texas Health Science Center School of Public Health, Houston, TX, (2)Northwest Portland Area Indian Health Board, Portland, OR, (3)Alaska Native Tribal Health Consortium, Anchorage, AK, (4)Inter Tribal Council of Arizona, Inc., Phoenix, AZ, (5)University of Texas Health Science Center-Houston, Houston, TX, (6)Oregon Health & Science University, Portland, OR, (7)University of Texas MD Anderson Cancer Center, Houston, TX, (8)Rice University, Houston, TX, (9)The Cooper Institute, Dallas, TX, (10)The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background and Objectives: American Indian and Alaska Native (AI/AN) youth face health disparities compared to other racial/ethnic groups. Internet-based health promotion programs may provide a viable strategy to reduce disparities. We assessed the feasibility of implementing six varied web-based health promotion programs for AI/AN youth in diverse tribal communities.
Methods: Data were collected from predominantly AI/AN youth, ages 12-14, participating in a randomized controlled trial at 25 sites in Alaska, Arizona, and the Pacific Northwest. Intervention group youth received an Internet-based sexual health program; comparison group youth received a suite of Internet-based programs on hearing loss, tobacco use, alcohol use, drug use, nutrition and physical activity. Feasibility parameters of computer access, connectivity, and bandwidth, and youth usability ratings on ease, credibility, impact, understandability, and motivational appeal were collected using previously validated measures.
Results: Overall, program connectivity was satisfactory despite variable bandwidth ranging from 0.24-93.5 Mbps (mean=25.6 +/- 31.1). The number of youth providing usability data varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN, mean age 13.1-13.3 years). However, across programs, youth rated the programs as likeable (59-87%), easy to use (68-91%), trustworthy (61-89%), and impactful (63-91%). Most youth understood the words in the programs (60-83%) although some needed adult assistance (16-49%). Overall, 37-66% would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons.
Conclusions: Findings demonstrate the feasibility of Internet-based health promotion programs among AI/AN youth. Dissemination of web-based health promotion programs may be a promising strategy for this population.
Administer health education strategies, interventions and programs Communication and informatics Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
Screening, Detection, and Management of Trauma in American Indian and Alaska Native Communities
Laurie Moore, MPH
University of Colorado -Anschutz Medical Campus, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Trauma exposure is associated with adverse impacts on physical and behavioral health. American Indians and Alaska Natives (AI/AN) have higher rates of trauma than their non AI/AN counterparts. Because primary care is the de facto behavioral health care system for most AI/ANs, trauma screening and trauma-focused intervention in the primary care setting is a logical step towards ameliorating persistent physical/behavioral health disparities among AI/ANs.
Using a community-based participatory research (CBPR) approach, we developed a screening, brief intervention, and referral process for trauma among AI/AN adults. The process was tested for feasibility in two Tribal primary care settings with 100 patients. A steering committee of behavioral health researchers, clinicians, and tribal members from each participating community informed the selection of the Primary Care – Post Traumatic Stress Disorder Screen (PC-PTSD) for use in the study. One focus of this effort was to compare results from the PC-PTSD to the research version of the Structured Clinical Interview for DSM IV-TR Axis One Disorders (SCID-I-RV) to test the validity of the PC-PTSD with this population. A subset of 42 participants completed the SCID-I-RV and these data were compared to screener outcomes. Preliminary results of these comparisons will be shared along with details about the CBPR process used to develop the screening program. Findings from this study may increase understanding of how restructuring primary care processes to facilitate the detection and initial management of trauma can be accomplished in ways that are acceptable and sustainable in two distinct health care settings.
Administer health education strategies, interventions and programs Implementation of health education strategies, interventions and programs Provision of health care to the public
Abstract
Getting to the root: Understanding the origins of racial misclassification in mortality data
Samantha Lucas-Pipkorn, MPH1 and Hawi Teizazu, BS2
(1)Great Lakes Inter-Tribal Epidemiology Center, Minneapolis, MN, (2)Centers for Disease Control and Prevention, Minneapolis, MN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
American Indian/Alaska Natives (AI/ANs) are a distinct and unique population that experience a disproportionate burden of disease in the United States. Accurate, timely data play a critical role in informing policies and allocating resources on the local, state, and federal level. As an expression of the federal trust responsibility, Tribal Epidemiology Centers (TECs) were created to build the capacity of Tribes and urban Indian communities to collect and use health related data while advocating on the national and state level for the appropriate inclusion of AI/ANs in surveys and public health surveillance. The Great Lakes Inter-Tribal Epidemiology Center (GLITEC) serves federally recognized Tribes and urban Indian areas in the Bemidji Area (Minnesota, Wisconsin, Michigan, and the city of Chicago). Racial misclassification occurs when a person's racial identity is not recorded or reported accurately. Several publications have demonstrated racial misclassification of AI/ANs in multiple state and federal registries, such as Surveillance, Epidemiology, and End Results (SEER) database. GLITEC sought to understand how race was recorded on death certificates in practice rather than theory in the Bemidji Area. GLITEC created a model of how data are first reported from the initial death certificate to synthesis of those data at the state and federal level in the Bemidji Area.
Diversity and culture Other professions or practice related to public health
Abstract
A multi-level, multi-component adult obesity intervention approach leads to increased physical activity in three American Indian communities
Leslie Redmond, MS, RD1, Marla Pardilla, MPH, MSW1, Jacqueline Swartz2, Thomas Eckmann, MS2 and Joel Gittelsohn, PhD2
(1)Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, (2)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: Obesity is a growing burden, especially amongst American Indians and Alaska Natives (AIANs). OPREVENT is a multi-level, multi-component (MLMC) obesity intervention focused on improving diet and physical activity habits of adult AI by increasing knowledge, building self-efficacy, and influencing intentions for improved behavior change. Developed through collaborative formative work with five tribal communities, OPREVENT encourages tribal sovereignty and aims to create culturally appropriate and sustainable health strategies.
Methods: Five AI communities (three in New Mexico, two in Michigan) were randomized to Round 1 (intervention, n=3) or Round 2 (delayed intervention, n=2). The MLMC program, consisting of store, worksite, school, and media components, was then implemented over the course of one year in the three Round 1 communities. Intervention messages were reinforced across the various components, with physical activity specifically emphasized within the worksites, primarily through implementation of worksite team pedometer challenges. Physical activity levels were assessed at baseline and follow-up using a modified International Physical Activity Questionnaire-Short Form (IPAQ-SF).
Results: Physical activity levels were assessed in 180 participants. Participants in Round 1 communities spent a significantly greater number of days per week engaged in vigorous physical activity at follow-up as compared to Round 2 communities (3.02 days as compared to 1.8 days; p=0.001).
Conclusion: Multi-level, multi-component intervention programs can be effective in promoting physical activity health behavior change in AI adults. Improvements in physical activity can reduce risk for obesity and other chronic diseases. When developed in collaboration with tribal communities, tribal sovereignty is reinforced and encouraged.
Chronic disease management and prevention Diversity and culture Implementation of health education strategies, interventions and programs
Abstract
Supporting Pascua Yaqui Youth Success: Building and Maintaining Trust in a Community-Based Assessment and Evaluation Partnership
Corrie Brinley, MSW1, Claudia Powell, M.Ed.2, Dennis Noonan, LCSW3 and Angela Valenzuela3
(1)University of Arizona, Tucson, AZ, (2)The University of Arizona, Tucson, AZ, (3)Pascua Yaqui Tribe, Tucson, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
In efforts to promote community healing and eliminate health disparities, indigenous communities recognize the value of including research and evaluation in community serving systems. These efforts, however, are often challenged by the realities of the not so distant past. Many indigenous communities who have experienced historical trauma all too often have also had to shoulder the burden of exploitive and misrepresented research and health services. These negative experiences have understandably led to a systemic distrust of researchers and health providers, as well as a strong negative association with the academic research community and process. At times, these challenges are further exacerbated by the proximate grief and trauma many indigenous people experience. Reciprocal research relationships built on platforms of respect and relevance must be cultivated in order to reverse these negative patterns and begin to build trust between indigenous and academic research communities.
The proposed workshop will highlight culturally grounded methods for measuring outcomes using community-based participatory research (CBPR) for indigenous youth and their families. These methods were developed by the Pascua Yaqui tribe in collaboration with the University of Arizona's Southwest Institute for Research on Women for The Pascua Yaqui Tribal Expansion Project (PYTEP). PYTEP is a system of care (SOC) expansion project for Pascua Yaqui youth aged 9 to 21 years old. The project seeks to further develop a coordinated network for clinical and primary prevention services using on evidence based, culturally relevant approaches for Pascua Yaqui youth and their families.
Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Planning of health education strategies, interventions, and programs Program planning
Abstract
Alaska's Community Health Workers Respond to a Collaboratively Developed, Culturally-Responsive Cancer Education Curriculum
Katie Cueva, ScD, MAT, MPH1, Melany Cueva, RN, EdD2, Regina Kuhnley, RN, CNM, M.Ed2, Anne Lanier, MD, MPH2, Mark Dignan, PhD, MPH3 and Laura Revels, BA2
(1)University of Alaska Anchorage, Anchorage, AK, (2)Alaska Native Tribal Health Consortium, Anchorage, AK, (3)University of Kentucky, Lexington, KY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction:
Alaska's village-based primary care providers - Community Health Aides and Practitioners (CHA/Ps) - requested information about cancer for themselves and their communities that would overcome geographic and economic barriers by being accessible via the Internet. In response, a research team at the Alaska Native Tribal Health Consortium developed a successful application to the National Cancer Institute to create a culturally-respectful distance-delivered cancer education course with, and for, Alaska's CHA/Ps.
Approach:
Interactive online cancer education modules were created on topics including Men's Health, Colorectal Cancer, Cancer and Our Genes, and Cancer Basics. Each of these modules was reviewed by a community advisory board of CHA/Ps and partners. The revised versions were published online through the Alaska Community Health Aide Program Training Center as CHA/P continuing education. While evaluation is iterative and ongoing, 119 module evaluations were collected between March 2015 and January 2016.
Results:
Similar to employed CHA/P demographics, individuals who provided evaluations were predominantly female (87%) and Alaska Native/American Indian (73%). All respondents reported that they had learned what they hoped to learn, and 96% shared that the modules were respectful of their culture. Respondents shared that they would use the information they learned in the cancer education modules with their patients (71%), family (54%), friends (48%), and with their communities (55%). Most respondents (76%) reported that the cancer education modules had made a difference in the ways they took care of themselves, including motivating CHA/Ps to reduce tobacco use, eat healthier, exercise more, and schedule cancer screening exams.
Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs Public health or related education Public health or related research
Abstract
Urban Indian Health Needs Assessment: Disparities in Methodology and Outcomes in Fargo, ND
Maylynn Warne, MPH1, Donald Warne, MD, MPH2 and Andrea Huseth-Zosel, PhD2
(1)North Dakota Public Health Association, Fargo, ND, (2)North Dakota State University, Fargo, ND
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Research design and sampling plans may exclude adequate Urban Indian participation in community health needs assessments. The Urban Indian (UI) population was underrepresented in previous health needs assessments conducted in the Fargo-Moorhead area (2013 and 2015). The purpose of this survey was to obtain information related to perceptions from residents of Fargo, North Dakota and Moorhead, Minnesota regarding community health, their personal health, preventive health, disease prevalence, and access to health care and health coverage. Health needs assessments lacking accurate data from disparate populations makes community planning efforts applicable only to the larger community. Primary data collection methods for the general survey for Fargo area residents used a stratified random sample of 1,500 names and addresses to mail a 54 question survey. UI representation was reported in the general survey as 0.1% of 382 respondents. UIs make up approximately 7% of the total population in the greater Fargo area. The general survey did not capture the needs of the UI population, and the NDSU research team and the North Dakota Public Health Association were engaged to promote improved community participation to collect data. Results of the UI health needs assessment were compared with the 2015 general assessment for the Fargo-Moorhead area. The UI community was engaged at community and cultural events and 96 completed surveys were obtained. The UI data is reflective of state and national data showing disparities in income, education, chronic diseases, and mental health.
Advocacy for health and health education Diversity and culture Public health or related research
Abstract
American Indian Public Health Resource Center: A model for university/tribal engagement
Melanie Nadeau, PhD, MPH
North Dakota State University, Fargo, ND
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction: The purpose of the American Indian Public Health Resource Center (AIPHRC) at North Dakota State University is to address public health disparities through technical assistance, policy development, self-determination feasibility analyses, education, research, and programming in partnership with tribes.
Objective: To describe the AIPHRCs model for university/tribal engagement.
Methods: The AIPHRC has conducted tribal tours with four tribes in North Dakota. The tribal tours consisted of meet-n-greets with tribal leadership and organizations. Community forums are scheduled to take place in each community during the spring/summer of 2016. As part of the engagement process, the AIPHRC is creating a tribal engagement tool-kit which will be informed by AIPHRC staff, stakeholder interviews and a focus group.
Results: Two tribal tours have been conducted in each community since August 2014. An internal focus group was conducted with North Dakota State University employees (n=10) in January 2016. Stakeholder interviews were conducted with AIPHRC staff and stakeholders from the tribes and the North Dakota Department of Health.
Conclusion: Once a draft of the toolkit is finalized in March 2016, the toolkit will be shared with the AIPHRC tribal advisory committee as well as tribal leaders in each community.
Limitations: The AIPHRC used a convenience sample in creating the tribal engagement tool-kit which may have led to an under or over representation of stakeholders. Although convenience sampling is easy to carry out in terms of cost and time, the findings may not be representative which limits the generalizability of the information to the American Indian population.
Implementation of health education strategies, interventions and programs Public health or related education Public health or related public policy Public health or related research
Abstract
Engaging American Indians in Community-Academic Collaborations
Tara M. Chico-Jarillo, MPH1, Nicolette I. Teufel-Shone, PhD1 and Anna Schwartz, PhD, FNP-BC, FAAN2
(1)University of Arizona, Tucson, AZ, (2)Northern Arizona University, Flagstaff, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
American Indian (AI) communities are resilient yet are rarely acknowledged for their achievements. The Center for American Indian Resilience has championed a paradigm shift in American Indian (AI) health promotion to focus on asset-based approaches to promoting health equity for AI communities. This shift has been operationalized by funding university based students and junior investigators and tribal partners to build community-academic collaborations. These community-academic partners are often facilitated by senior investigators who have long standing tribal relationships. These emerging partnerships identify a short term task needed to strengthen an evolving collaboration by integrating academic skills with community experience. All partnerships use a community based participatory (CBP) approach with the goal of enhancing assets and supporting community resilience. In the first cohort, 5 collaborative projects were funded: 1) documenting health aging in AI elders, 2) sharing stories of successful AI youth with disabilities, 3) reporting the strategies used to engage youth as agents of change in community health, 4) reinforcing sports as a cultural strength, and 5) addressing uranium contamination of traditional foods. Each project university and community co-leads attended a CBP training and were mentored to build an equitable process of project implementation. The goal is promoting community resilience by drawing on the experience of the community and the foundations of public health offered by academia.
Diversity and culture