Despite California’s large American Indian and Alaska Native (AI/AN) population, there has been a persistent lack of data available to identify and address AI/AN maternal and infant health priorities. Causes of this data gap include suppression of AI/AN data due to racial misclassification in standard data reporting procedures and small numbers of AI/AN women in surveys such as the Maternal and Infant Health Assessment (MIHA).

This presentation will describe the process and results of a multi-year effort by the California Department of Public Health (CDPH) to improve AI/AN maternal and infant health surveillance. First, CDPH established relationships with tribal and urban Indian data stakeholders to provide guidance to all aspects of this effort. Then, CDPH oversampled AI/AN women in MIHA (California’s PRAMS-like postpartum survey). Importantly, CDPH conducted a comprehensive assessment of AI/AN data definitions and established an expanded definition of AI/AN for ongoing use in data reporting. Finally, in collaboration with tribal and urban Indian partners, CDPH released the California American Indian/Alaska Native Maternal and Infant Health Status Report, which included estimates on over 50 topics from vital statistics, MIHA and hospital discharge datasets.

Benefits of this effort for tribes and urban Indian organizations include increased availability of data to inform culturally-specific AI/AN maternal and child health policies and programs. Benefits for CDPH include better relationships with and a more comprehensive understanding of the health needs of California AI/AN communities, improved equity in CDPH data availability, improved AI/AN maternal and infant health surveillance, and enhancements in overall epidemiologic capacity.

background: Dine College (tribal college of Navajo Nation), Northern Arizona University, and the Navajo Epidemiology Center collaboratively implemented the first Navajo Maternal Child Health (MCH) Needs Assessment to provide more culturally representative and comprehensive information for Arizona Department of Health Services’ 2020 Title V report.

methods: The team included public health students, masters level staff and faculty. An advisory group of MCH professionals on Navajo Nation (NN) guided the assessment process. Secondary data, obtained through limited datasets and existing reports, were systematically reviewed, categorized, and analyzed by students during their senior capstone course. ‘Input Events’ used community gatherings to ask caregivers about their use of and suggestions for MCH services. Participants provided anonymous, written responses. Responses were analyzed by masters of public health students.

results: Reponses from more than 75 parents, adolescents, and other caregivers were integrated with the secondary data analysis and advisory group feedback to yield a framework to inform NN specific MCH infrastructure. Priorities areas were: 1) education 2) healthcare 3) children with special health care needs, and 4) behavioral health.

conclusion: The first NN MCH Needs Assessment used collaborative, mixed methods. The process promoted public health skills development for undergraduate and graduate students, and aimed to provide community-identified context to the MCH needs and assets on Navajo Nation. This report will be included in the 2020 Arizona Department of Health Services MCH Needs Assessment, and will serve as a resource for the NN programs and professionals to improve overall health of Navajo families and future generations.

Background: In contrast to existing best practices for identifying stakeholders, less is known about effective strategies for engaging diverse stakeholder groups in developing health promotion programs. This presentation describes a collaboration between the University of Arizona and the Tucson Indian Center (TIC) to develop a program to prevent alcohol-exposed pregnancies (AEPs) among urban American Indians (AI). By applying community-based participatory research principles, program planning focused heavily on culturally-appropriate stakeholder engagement activities. Methods: The University team involved TIC administrators, staff, board members, clients, and community members in developing the AEP prevention program. Engagement strategies were tailored for different groups and included regular meetings with administrators, consultation with staff, presentations at board meetings, presentations and focus group interviews with TIC clients, and participation at large community events. Results: The engagement strategies resulted in community buy in for the project. The University team were invited to participate in client group meetings and community events. With support from all stakeholder groups, the University team successfully completed a comprehensive needs assessment to inform program development. Conclusion: Stakeholder engagement was critical to the success of the first year of the project, and will be equally important for the second year. The second year of the project will include report back of findings and community forums to assist with the prioritization of target groups and program components. Ongoing engagement activities will increase the likelihood that the AEP prevention program is feasible, acceptable and sustainable by the TIC and the community.

Adherence to regular screening mammography provides the greatest benefit in life years gained from early breast cancer detection. An Indian Health Service mobile mammography unit (MMU) traveled >4,500 miles annually to 22 predominantly rural clinics across 4 states in the Great Plains from 2013-17. We compared screening mammography adherence among American Indian (AI) female patients screened at the MMU with the American College of Radiology’s National Mammography Database (NMD), from 2013-16.

For AI female patients ages >42 years screened by the MMU, age and screening mammography dates were extracted from medical records. Adherence was defined as having a mammogram 9-27 months prior to MMU presentation. Those with a previous mammogram dated >27 months or those with no evidence of any prior mammogram were classified as not adherent. Patients whose last prior mammogram occurred <9 months before screening at the MMU were excluded.

Among 1,616 MMU patients ages 42-87 years, 634 (39.2%) were adherent to screening. Among 309,794 NMD patients ages 45-80 years, 185,132 (59.8%) were adherent to screening. A Chi-Square test showed a significant difference in adherence between the MMU and the NMD (p<0.0001). Additionally, the odds of an MMU patient being non-adherent are 2.3 times higher than for an NMD patient.

Most female patients screened by the MMU were not adherent to screening mammography, suggesting persistent health disparities. Although adherence for MMU patients is significantly lower than the NMD, the MMU increases AI women’s access to screening mammography. Without the MMU, screening adherence may decrease.