Search

This paper reports the strategies used to track and follow 3,828 Alaska Native and American Indian study participants in the city of Anchorage and more rural areas of Alaska and provides characteristics of respondents and non-respondents. Over 88% were successfully followed-up, with 49% of respondents completed in three or fewer attempts. Follow-up completion rates were significantly higher for women, those living in a rural area, over age 55, married, employed, having a higher household income, and at current residence for more than five years. Follow-up of large numbers of Alaska Native and American Indian people living in geographically diverse areas is feasible, although challenging. Successful strategies to avoid attrition include using telephones as the primary method of contact; using a computerized contact relationship management system to track efforts and manage data; obtaining contact information from participant contact networks, medical records, and community networks; using local village interviewers to contact participants without telephone service; and mailing paper questionnaires to participants who are incarcerated or use social services.

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth. (Contains 1 table.)

Community Health Aides and Community Health Practitioners (CHA/Ps), the primary providers of healthcare in rural Alaska, share the importance of story as a culturally respectful way for creating meaning and broadening understanding. Story is woven into the fabric of cancer education courses for CHA/Ps. Between May 2004 and April 2007, 13 week-long cancer education courses were provided for CHA/Ps. In response to the written, end-of-course, evaluation question, "Do stories help you to learn? If yes, how?" Ninety-six percent (96%) of respondents (99/103) described ways that story supported their learning. Additionally, in May 2005, 293 (65%) of the 454 CHA/Ps responded in writing to a mailed cancer education survey. Of the survey respondents, 240 (86%) were women and 239 (86%) were Alaska Native people. Nearly all, 98% (224/229) of Alaska Native people and 93% (37/40) of non-Native people identified story as helping them learn. CHA/Ps, on both the cancer education course evaluations and the CHA/P written survey, identified story as a pathway for connecting people, facilitating understanding, enhancing remembering, engendering creativity, expanding perspective, envisioning the future and inspiring possibility. Through stories we share our feelings, heal wounds, deepen understanding, strengthen community and discover hope.

Background: Nationwide, the incidence of thyroid cancer is lower among American Indian/Alaska Native (AI/AN) people than among U.S. whites (USW). However, little is known about the incidence of thyroid or other endocrine cancers specifically among Alaska Native (AN) people. Methods: Data were examined from the National Cancer Institute's Surveillance, Epidemiology, and End Results Alaska Native Tumor Registry on endocrine cancers diagnosed among AN people from 1969–2013, with a specific focus on thyroid cancers. Frequencies of endocrine cancers by site and also of thyroid cancers by histology, size, and stage at diagnosis were evaluated. Distributions were compared to USW (Surveillance, Epidemiology, and End Results 9 Registries) using the chi-square test. Five-year average annual age-adjusted incidence rates of thyroid cancers were calculated, stratified by histology, age, and five-year period of diagnosis, and compared to those observed among USW. Five-year cause-specific survival was evaluated using cause of death data from the National Death Index Plus from the National Center for Health Statistics. Results: During the 45-year period (1969–2013), 224 endocrine cancers were diagnosed among AN people, of which 210 (94%) were thyroid cancers. Compared to USW, AN people were diagnosed at a slightly younger age, had a higher proportion of thyroid cancers diagnosed with a size of 20–40 mm, and a larger proportion of patients with regional metastases. More than 85% of AN thyroid cancers were of papillary histology. The incidence of thyroid cancers was similar between AN people and USW, and appeared to increase among AN people over the period of surveillance. Finally, five-year cause-specific survival rate was 100% for papillary carcinoma patients and 86.3% [confidence interval 54.7–96.5] for follicular thyroid cancer patients. Conclusions: This study is the first report of endocrine cancers and the first detailed examination of thyroid cancer among AN people. The incidence of thyroid cancer was similar among AN people and USW. However, compared to USW, AN people appear to be at risk for diagnosis at a younger age, larger size, and higher stage. Further research is needed to explore the causes of these differences. [ABSTRACT FROM AUTHOR]

Nicotine, the psychoactive ingredient in tobacco, is metabolically inactivated by CYP2A6 to cotinine. CYP2A6 also activates procarcinogenic tobacco-specific nitrosamines (TSNA). Genetic variation in CYP2A6 is known to alter smoking quantity and lung cancer risk in heavy smokers. Our objective was to investigate how CYP2A6 activity influences tobacco consumption and procarcinogen levels in light smokers and smokeless tobacco users. Cigarette smokers (n = 141), commercial smokeless tobacco users (n = 73) and iqmik users (n = 20) were recruited in a cross-sectional study of Alaska Native people. The participants’ CYP2A6 activity was measured by both endophenotype and genotype, and their tobacco and procarcinogen exposure biomarker levels were also measured. Smokers, smokeless tobacco users and iqmik users with lower CYP2A6 activity had lower urinary total nicotine equivalents (TNE) and (methylnitrosamino)-1-(3)pyridyl-1-butanol (NNAL) levels (a biomarker of TSNA exposure). Levels of N-nitrosonornicotine (NNN), a TSNA metabolically bioactivated by CYP2A6, were higher in smokers with lower CYP2A6 activities. Light smokers and smokeless tobacco users with lower CYP2A6 activity reduce their tobacco consumption in ways (e.g. inhaling less deeply) that are not reflected by self-report indicators. Tobacco users with lower CYP2A6 activity are exposed to lower procarcinogen levels (lower NNAL levels) and have lower procarcinogen bioactivation (as indicated by the higher urinary NNN levels suggesting reduced clearance), which is consistent with a lower risk of developing smoking-related cancers. This study demonstrates the importance of CYP2A6 in the regulation of tobacco consumption behaviors, procarcinogen exposure and metabolism in both light smokers and smokeless tobacco users. [ABSTRACT FROM PUBLISHER]

Introduction:: While aggregate rates of tobacco use for Alaska Native (AN) and American Indian people are high, use rates vary among populations and factors associated with use are not fully understood. For AN people living in three regions of Alaska, we present prevalence of tobacco use as well as factors associated with use. [ABSTRACT FROM PUBLISHER]

Objectives. Alaska Native (AN) women have exhibited some of the highest incidence rates of cancer overall, and different patterns of site-specific incidence compared to other U.S. populations. This study compares incidence rates between AN and U.S. white women (USW) for cancers of the breast, uterus, ovary and cervix, and examines effects of time period and birth cohort as determinants of incidence trends among AN women. Study design. Observational, population-based study. Methods. Cancer incidence data from the Alaska Native Tumor Registry and SEERStat, 1974- 2003. Age-adjusted World Standard Population rates were calculated for a current 5-year period and over time (30 years), and compared to other populations using rate ratios with 95% confidence intervals. Log-linear regression models used to assess impact on trend of age, time period and birth cohort. Results. Compared to U.S. white women, current cancer rates among AN women are not significantly different for cancer of the breast and cervix, and significantly lower for cancers of the ovary and uterus. Trends over time over a 30-year time period also differ for these cancer sites. There were significant increases in breast and uterine cancer, and in contrast, a marked decline in cervical cancer. There was no significant change for cancer of the ovary. Changes appear to be due largely to period, not birth cohort effects. Conclusions. Increases in breast cancer may be due to a combination of modifiable behaviours; increased BMI and a shift to a non-traditional diet. Increases in uterine cancer could be associated with increased BMI and diabetes. Cervical cancer rates have declined to USW levels. The marked decline is likely due to enhanced screening and control efforts within the Alaska Native Tribal Health System (formerly Alaska Area USPHS, Indian Health Service utilizing resources available from the Centers for Disease Control tribal and state Breast and Cervical Cancer Early Detection Programs). [ABSTRACT FROM AUTHOR]

Objectives. We aimed to describe the epidemiology of stroke among Alaska Natives, which is essential for designing effective stroke prevention and intervention efforts for this population. Methods. We conducted an analysis of death certificate data for the state of Alaska for the period 1984 to 2003, comparing age-standardized stroke mortality rates among Alaska Natives residing in Alaska vs US Whites by age category, gender, stroke type, and time. Results. Compared with US Whites, Alaska Natives had significantly elevated stroke mortality from 1994 to 2003 but not from 1984 to 1993. Alaska Native women of all age groups and Alaska Native men younger than 45 years of age had the highest risk, although the rates for those younger than 65 years were statistically imprecise. Over the 20-year study period, the stroke mortality rate was stable for Alaska Natives but declined for US Whites. Conclusions. Stroke mortality is higher among Alaska Natives, especially women, than among US Whites. Over the past 20 years, there has not been a significant decline in stroke mortality among Alaska Natives. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to develop a dietary instrument (food frequency questionnaire [FFQ]) that measured total dietary intake over 1 year among Alaska Native people in 2 regions. Ways of assessing diet are needed in order to accurately evaluate how the diets of Alaska Natives relate to their health. Study design. Seasonal 24-hour (24-h) diet recalls were collected for developing an FFQ that described the average dietary foods and nutrients consumed. Alaska Native people living in 12 small communities in 2 regions of the state were eligible to participate. Methods. Each participant was to provide 4 24-h diet recalls, 1 per season. Recalls were used to develop an FFQ using regression techniques. The FFQ was administered to 58 of the 333 original participants. Responses to the FFQ were compared to the averages of their 24-h recalls using the Spearman Correlation Coefficient. Results. Energy-adjusted correlations ranged from 0.15 for protein to 0.49 for monounsaturated fatty acids. Fifteen of 26 nutrients examined were significantly correlated (total carbohydrates, sucrose, fructose, total fat, fatty acids [monounsaturated, polyunsaturated, omega 3, EPA, DHA], folate, vitamins A, C, D, potassium and selenium). Conclusions. The FFQ can be used to evaluate intakes of Alaska Natives in western Alaska for the correlated nutrients. [ABSTRACT FROM AUTHOR]

Objectives. To determine the prevalence of traditional food and physical activity use and associations with cultural factors among 3,830 Alaska Native and American Indian (AN/AI) people enrolled in the Education and Research Towards Health (EARTH) Study in 3 regions of Alaska. Study design. Cross-sectional analysis of baseline data from a cohort study. Methods. Participants (2,323 women and 1,507 men) completed a computer-assisted self-administered questionnaire that included information on diet, physical activity, life-style and cultural factors. Results. Over 92% of participants reported eating at least 1 traditional food in the past year. The top 3 traditional foods reported were fish, moose and agutaq (a mixture of berries and fat). The percentage of people who consumed traditional foods varied by region and age but not by sex (p<0.01). Almost 70% of participants engaged in at least one traditional harvesting physical activity. Picking berries or greens, cutting/smoking fish or meat and fishing were the most common activities. Participation in traditional physical activity was highest in south-west Alaska and was higher among men than women, but did not differ by age (p<0.01). Both traditional food and physical activity were associated with greater tribal self-identification, speaking a Native language at home, using traditional remedies and participating in or attending traditional events (p<0.05). Conclusions. The EARTH Study found relationships between traditional food use, physical activities, cultural activities and behaviours. Consumption of a variety of traditional foods and participation in traditional physical activities remain an important part of the contemporary Alaska Native life-style. Efforts to promote and sustain these foods and activities in AN/AI populations may lead to improved health outcomes. [ABSTRACT FROM AUTHOR]

Although in the past, rates of heart disease, cancer, and diabetes were lower in Alaska Natives than in US whites, these diseases are now increasing. The rate of iron-deficiency anemia for Alaska Natives continues to be higher than that in the general population. To understand the role of diet in these chronic diseases, seasonal dietary intakes of 351 Alaska Native adults from 11 communities were assessed during 1987-1988. Alaska Natives consumed more energy (19%), protein (39%), fat (21%), carbohydrate (13%), iron (25%), vitamin A (53%), and vitamin C (31%), but less calcium (19%) than did the general US adult population [National Health and Nutrition Examination Survey II (NHANES II)]; Alaska Natives consumed six times more fish but less fruits and vegetables. Results suggest that energy and protein intakes decreased in the last 30 y but the proportion of energy from fat (37%) remained unchanged. High fish consumption and large seasonal dietary variations persisted, which may protect against chronic diseases. However, excess energy and fat and low calcium, fruit, and vegetable intakes may be contributing to recent increases in chronic diseases. Dietary guidelines are proposed. [ABSTRACT FROM AUTHOR]

Purpose. Assessment of self-reported physical activity (PA) and effects on health measures. Design. Cross-sectional analysis of baseline data from a cohort study. Setting. Education and Research Towards Health study participants from Alaska and the Southwestern United States enrolled from 2004 to 2007. Subjects. Total of 10,372 American Indian and Alaskan Native people (AI/AN) of at least 18 years. Measures. Participants completed computer-assisted, self-administered questionnaires, and anthropometric and health measurements were taken of each participant. Analysis. Analysis of variance, X² tests, and multiple linear regressions were used. Results. Almost 23% of participants reported less than 30 minutes per week of moderate or vigorous activities. Half (49%) reported no vigorous activities. Characteristics associated with more time spent performing vigorous activity were male gender, age less than 40 years, higher income and education levels, and living in a rural area. Almost 70% of Alaskan participants and 36% of Southwest participants engaged in wild food-harvesting activities. Participants with higher levels of activity had significantly better clinical characteristics (high-density lipoprotein cholesterol, triglycerides, body mass index, and waist circumference). Conclusion. AI/AN people engage in many different physical activities, including traditional harvesting activities. Women had lower levels of PA than men, and participation in vigorous PA was associated with better clinical characteristics. These data can be used to guide health promotion efforts in AI/AN populations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few studies have investigated depression among Alaska Native people (ANs). Depression prevalence and associated factors among EARTH Alaska study participants are described. Methods: The nine-item Patient Health Questionnaire (PHQ-9) assessed depression among 3771 ANs. Participants with PHQ-9 scores≥10 out of 27 were classified as positive for depression. Logistic regression analyses evaluated odds of scoring positive versus negative for depression by demographic, cultural, then health and lifestyle factors. Results: Twenty percent of women and 13% of men scored positive for depression. Univariate and multivariate models were fit separately for men and women. Among demographic factors, below median income was associated with positive depression scores for both genders. Among men, odds of depression were higher if unmarried and/or if highest educational level was less than high school. Women 34 to 59years of age had increased odds of scoring positive. Little or no identification with tribal tradition was associated with increased odds of depression in women and decreased odds in men. For both genders, chronic physical conditions and poorer self-reported health were associated with positive depression scores then binge alcohol drinking and current tobacco use increased odds of depression among women only. Limitations: Factors analyzed were self-reported without clinician follow-up in a non-random convenience sample of adults. Conclusions: Depression is common among ANs with rates comparable to other indigenous cross-sectional investigations. Depression is associated with lower income and poorer physical health. Prevention and intervention efforts should consider gender as other associated factors varied between men and women. [Copyright &y& Elsevier]